Organization Active NPI

Healthsource of Meridianville

  • Chiropractor
  • Meridianville, AL
National Provider Identifier
1629882121
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
HEALTHSOURCE OF MERIDIANVILLE
Practice address
11850 Highway 231 431 N Ste J
Meridianville, AL 35759-2126
Phone
(217) 381-7825
NPI assigned
Feb 4, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

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

Authorized official

Name
Jacob Dean Mathias
Title
Managing Member
Phone
(256) 874-2643

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

11850 Highway 231 431 N Ste J
Meridianville, AL 35759-2126

Mailing address

11850 Highway 231 431 N Ste J
Meridianville, AL 35759-2126
Phone (217) 381-7825

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250306003627 AL Part B Supplier - Clinic/Group Practice 5294256236 Receives reassigned benefits from 1 practitioner
Practice locations: Meridianville, AL

National Provider Directory

National Provider Directory

Locations

11850 Highway 231 431 N
Ste J
Meridianville, AL 35759
Phone (217) 381-7825

11836 Highway 231 431 N
Ste J
Meridianville, AL 35759
Phone (217) 381-7825

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1738627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739404800000",
    "number": "1629882121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11850 HIGHWAY 231 431 N STE J",
            "city": "MERIDIANVILLE",
            "state": "AL",
            "postal_code": "357592126",
            "telephone_number": "217-381-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11850 HIGHWAY 231 431 N STE J",
            "city": "MERIDIANVILLE",
            "state": "AL",
            "postal_code": "357592126",
            "telephone_number": "217-381-7825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE OF MERIDIANVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-04",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A",
        "authorized_official_last_name": "MATHIAS",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "256-874-2643"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridianville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; 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.