Jacksonville Chiropractic P. a.

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

JACKSONVILLE CHIROPRACTIC P. A.

Practice address

1727 T P White Dr
Jacksonville, AR 72076-2861

Phone

(501) 985-7711

Fax

(501) 985-8385

NPI assigned

Nov 8, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Blake W Bennett, D.C.NPI 1548234115

Title

Owner

Phone

(501) 985-7711

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in AR

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.

• Blake W Bennett, D.C.

  • Chiropractor
  • Jacksonville, AR
  • NPI 1548234115
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1194480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217894400000",
    "number": "1629258595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1727 T P WHITE DR",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720762861",
            "telephone_number": "501-985-7711",
            "fax_number": "501-985-8385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1727 T P WHITE DR",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720762861",
            "telephone_number": "501-985-7711",
            "fax_number": "501-985-8385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE CHIROPRACTIC P. A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-08",
        "last_updated": "2008-08-05",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-985-7711",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP MEMBER PTAN",
            "identifier": "5T401",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "5F994",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "U63233",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aaron Joseph Irvin I, DDS
• Katherine Isenberg
• Rebecca Williams Jackson, LAC
• Sheryl Jackson, LPC
• Jacksonville Care Center, LLC
• Jacksonville Emergency Medicine LLC
• Jacksonville North Pulaski School District
• Jacksonville Physical Therapy
• Jacksonville Smile Canter
• Jacksonville Vision Development Center PA

• Chiropractor in Jacksonville, AR
• Providers in Jacksonville, AR by specialty
• Chiropractor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2008; 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.