Brandon T. Jackson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2011014558 Issued in MO

Practice address

5551 Winghaven Blvd Ste 20
O Fallon, MO 63368-3618

Phone

(636) 614-0401

Fax

(636) 265-0014

NPI assigned

Sep 15, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jackson Chiropractic

  • Chiropractor
  • O Fallon, MO
  • NPI 1669728101
  NPD (past)
• Millard Family Chiropractic of Papillion LLC

  • Chiropractor
  • Papillion, NE
  • NPI 1942851100
  NPD (past)

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

{
    "created_epoch": "1252972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648857600000",
    "number": "1578896031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5551 WINGHAVEN BLVD STE 20",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633683618",
            "telephone_number": "636-614-0401",
            "fax_number": "636-265-0014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5551 WINGHAVEN BLVD STE 20",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633683618",
            "telephone_number": "636-614-0401",
            "fax_number": "636-265-0014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRANDON",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-09-15",
        "last_updated": "2022-04-02",
        "certification_date": "2022-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2011014558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH NUMBER",
            "identifier": "12014762",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christina Marie Ivy, FNP-C
• Daniel Jablonski, D.C.
• Jack W. Haney, D.D.S., P.C.
• Jackson Chiropractic
• Bradley C Jackson
• Garrett Rodney Jackson, D.C.
• Sarah Marie Jackson, DO
• Heidi Kathleen Jacobs, FNP
• Jake Schmitz Chiropractic LLC
• Roham Jalilian

• Chiropractor in O Fallon, MO
• Providers in O Fallon, MO by specialty
• Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.