Individual provider Active NPI

Paul Dante Jacoy, D.C.

  • Rehabilitation Practitioner
  • Pasadena, CA
National Provider Identifier
1598767642
Registry record updated Feb 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation PractitionerTaxonomy code 225400000X
Practice address
100 W Walnut St Ste 375
Pasadena, CA 91124-1220
Phone
(323) 257-9600
NPI assigned
Jun 1, 2005
Last updated
Feb 25, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 25, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician Chiropractor 111NS0005X DC22376 CA
Rehabilitation Practitioner 225400000X NU Primary

Addresses

Primary practice location

100 W Walnut St Ste 375
Pasadena, CA 91124-1220

Mailing address

111 S Oak Knoll Ave Apt 101
Pasadena, CA 91101-2681
Phone (626) 825-2621

Other practice location 1

111 S Oak Knoll Ave Apt 101
Pasadena, CA 91101-2681
Phone (626) 825-2621

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

LicenseStateTypeSpecialty
DC22376CAMDSports Physician Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Arman Tchoukadarian D.C. Professional Chiropractic Corporation CurrentSince Jul 24, 2022 Accepting new patients

Locations

610 N Lake Ave
Pasadena, CA 91101
Phone (626) 585-1616

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551052800000",
    "number": "1598767642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S OAK KNOLL AVE APT 101",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911012681",
            "telephone_number": "626-825-2621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W WALNUT ST STE 375",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911241220",
            "telephone_number": "323-257-9600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 S Oak Knoll Ave Apt 101",
            "address_purpose": "LOCATION",
            "city": "Pasadena",
            "state": "CA",
            "postal_code": "911012681",
            "country_code": "US",
            "telephone_number": "626-825-2621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOY",
        "first_name": "PAUL",
        "middle_name": "DANTE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2019-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "CA",
            "license": "DC22376",
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; 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.