Active NPI
Corey Lamont Jackson Sr., D.C.
- Chiropractor
- Pine Bluff, AR
National Provider Identifier
1659419075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1684
- Practice address
- 1518 S Poplar St
Pine Bluff, AR 71601-6249 - Phone
- (870) 535-4878
- Fax
- (870) 850-0199
- NPI assigned
- Feb 1, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 1684 | AR | Primary |
Addresses
Primary practice location
1518 S Poplar St
Pine Bluff, AR 71601-6249
Mailing address
3615 W Hepburn St
Pine Bluff, AR 71603-2537
Phone (870) 692-6618
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 |
|---|---|---|---|
| 1684 | AR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1659419075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3615 W HEPBURN ST",
"city": "PINE BLUFF",
"state": "AR",
"postal_code": "716032537",
"telephone_number": "870-692-6618",
"fax_number": "870-540-0554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1518 S POPLAR ST",
"city": "PINE BLUFF",
"state": "AR",
"postal_code": "716016249",
"telephone_number": "870-535-4878",
"fax_number": "870-850-0199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "COREY",
"middle_name": "LAMONT",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "AR",
"license": "1684",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pine Bluff, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.