JKL Enterprises Inc

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

004440 Issued in MO

Legal business name

JKL ENTERPRISES INC

Doing business as

MID RIVERS CHIROPRACTIC

Practice address

7472 Mexico Rd
Saint Peters, MO 63376-1305

Phone

(636) 279-1400

NPI assigned

Oct 10, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

James Edward Lustig, D.C.NPI 1154425395

Title

Owner

Phone

(636) 279-1400

Specialties & licenses 1

Addresses

Other names 1

• MID RIVERS CHIROPRACTIC Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James Edward Lustig, DC

  • Chiropractor
  • St Peters, MO
  • NPI 1154425395
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318204800000",
    "number": "1407130347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7472 MEXICO RD",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761305",
            "telephone_number": "636-279-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7472 MEXICO RD",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761305",
            "telephone_number": "636-279-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JKL ENTERPRISES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-10",
        "last_updated": "2011-10-10",
        "status": "A",
        "authorized_official_last_name": "LUSTIG",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-279-1400",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MO",
            "license": "004440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MID RIVERS CHIROPRACTIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jenny L Wiemann DCPC
• Sara Maria Jensen, MD
• Nicole Renee Jett
• Keta Jhala, PHARMD
• Raj B Jhala
• John L. Young, M.D.
• Angela Mae Johnson, LPC
• Chauntreace Duprea Johnson, RN, BSN
• Dayonna Johnson
• Kayla Johnson

• Multi-Specialty Clinic/Center in Saint Peters, MO
• Providers in Saint Peters, MO by specialty
• Multi-Specialty Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.