Concordia Spine & Sport, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

01-05450 Issued in KS

Legal business name

CONCORDIA SPINE & SPORT, LLC

Practice address

208 W 6TH St
Concordia, KS 66901-2817

Phone

(785) 262-4344

NPI assigned

Dec 26, 2012

Organization subpart

No

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

Authorized official

Name

Jeremy Will, DCNPI 1003187790

Title

Chiropractor

Phone

(785) 262-4344

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Jeremy Will, D.C.

  • Chiropractor
  • Concordia, KS
  • NPI 1003187790
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1356480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677110400000",
    "number": "1649516451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 W 6TH ST",
            "city": "CONCORDIA",
            "state": "KS",
            "postal_code": "669012817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 W 6TH ST",
            "city": "CONCORDIA",
            "state": "KS",
            "postal_code": "669012817",
            "telephone_number": "785-262-4344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCORDIA SPINE & SPORT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-26",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A",
        "authorized_official_last_name": "WILL",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "785-262-4344",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "KS",
            "license": "01-05450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cloud County Health Center Inc
• Cloud County Health Center Inc
• Cloud County Health Center Inc
• Cloud County Health Center Inc
• Cloud County Health Center Inc
• County of Cloud
• County of Cloud
• Amy Crouse, LPN
• Suzanna Lu Dailey, P.T.A.
• Jonathan Dominguez

• All providers in Concordia, KS
• Chiropractor in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.