Active NPI
Jon A Paul, D.C.
- Chiropractor
- Rockford, IL
National Provider Identifier
1407851264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 038-003772
- Practice address
- 2477 Eastrock Dr
Rockford, IL 61108-8077 - Phone
- (815) 397-0935
- Fax
- (815) 397-3017
- NPI assigned
- Jun 17, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038-003772 | IL | Primary |
Addresses
Primary practice location
2477 Eastrock Dr
Rockford, IL 61108-8077
Mailing address
2477 Eastrock Dr
Rockford, IL 61108-8077
Phone (815) 397-0935
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038-003772 | IL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203292800000",
"number": "1407851264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2477 EASTROCK DR",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611088077",
"telephone_number": "815-397-0935",
"fax_number": "815-397-3017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2477 EASTROCK DR",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611088077",
"telephone_number": "815-397-0935",
"fax_number": "815-397-3017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAUL",
"first_name": "JON",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-17",
"last_updated": "2008-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IL",
"license": "038-003772",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.