Four-Ten Enterprise, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

12808 Issued in TX

Legal business name

FOUR-TEN ENTERPRISE, LLC

Practice address

1540 Rice Rd Ste 400
Tyler, TX 75703-3223

Phone

(903) 597-9021

Fax

(903) 597-0840

NPI assigned

Jun 22, 2017

Organization subpart

No

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

Authorized official

Name

Jimmy Brian Sullivan, DCNPI 1619368941

Title

Owner

Phone

(903) 597-9021

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Helping Hands Chiropractic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

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.

• Jimmy Brian Sullivan, DC

  • Chiropractor
  • Tyler, TX
  • NPI 1619368941
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673913600000",
    "number": "1619497401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 RICE RD STE 400",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033223",
            "telephone_number": "903-597-9021",
            "fax_number": "903-597-0840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 RICE RD STE 400",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033223",
            "telephone_number": "903-597-9021",
            "fax_number": "903-597-0840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR-TEN ENTERPRISE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-22",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-597-9021",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "12808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "583248",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Helping Hands Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Helping Hands Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kali Tova Foster, LVN
• Patrick Aaron Foster, LPC
• Rachel L Foster, MS. CFY-SLP
• Lindsey N Fountain, RN
• Four Seasons Women'S Health PA
• Rachel E Fouse, NP
• Ashley Fowble
• Jennifer Kaye Fowler, FNP
• Jody M Fowler
• James Gary Fox, MD

• Chiropractor in Tyler, TX
• Providers in Tyler, TX by specialty
• Chiropractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; 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.