Active NPI
Gilbert Joseph Jackson, D.C.
- Chiropractor
- Lafayette, CA
National Provider Identifier
1649350620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 19166
- Practice address
- 3249 Mt Diablo CT
Suite 102
Lafayette, CA 94549-4084 - Phone
- (925) 952-4222
- Fax
- (925) 592-4212
- NPI assigned
- Oct 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 19166 | CA | Primary |
Addresses
Primary practice location
3249 Mt Diablo CT
Suite 102
Lafayette, CA 94549-4084
Mailing address
3249 Mt. Diablo Court
Suite 102
Lafayettte, CA 94549-4050
Phone (925) 952-4222
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DC0191660 | Other | CA | PTAN# |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 19166 | CA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405036800000",
"number": "1649350620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3249 MT. DIABLO COURT",
"address_2": "SUITE 102",
"city": "LAFAYETTTE",
"state": "CA",
"postal_code": "945494050",
"telephone_number": "925-952-4222",
"fax_number": "925-952-4212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3249 MT DIABLO CT",
"address_2": "SUITE 102",
"city": "LAFAYETTE",
"state": "CA",
"postal_code": "945494084",
"telephone_number": "925-952-4222",
"fax_number": "925-592-4212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "GILBERT",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-16",
"last_updated": "2014-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "19166",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN#",
"identifier": "DC0191660",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.