JCC LLC
Organization Active NPI Chiropractor · Phoenix, MD
NPI 1649448374 · NPPES record last updated Feb 15, 2008
Key facts
- NPI
- 1649448374
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- S01332 (MD)
- Legal business name
- JCC LLC
- Practice address
- 14307 Jarrettsville Pike
Phoenix, MD 21131-1763 - Phone
- (410) 592-7300
- Fax
- (410) 666-0348
- NPI assigned
- Feb 15, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Daniel Thomas Wise, D.C.
- Title
- Doctor/Owner
- Phone
- (410) 592-7300
Practitioners 1
-
Daniel Thomas Wise, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140310001725 | MD | Part B Supplier - Clinic/Group Practice | 1456581669 |
Receives reassigned benefits from 1 practitioner Practice locations: Phoenix, MD |
National Provider Directory
Locations
14307 Jarrettsville Pike
Phoenix, MD 21131
Phone (410) 592-7300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | S01332 | MD | Yes |
Addresses
Primary practice location
14307 Jarrettsville Pike
Phoenix, MD 21131-1763
Mailing address
PO Box 38
14307 Jarrettsville Pike
Phoenix, MD 21131-0038
Phone (410) 592-7300
Other names
- Jacksonville Chiropractic Center
Other providers in Phoenix, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 15, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.