Active NPI
Jeremy D. Maxwell, DC
- Chiropractor
- Columbia, MO
National Provider Identifier
1669425070
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2000172546
- Practice address
- 2503 Bernadette Dr
Columbia, MO 65203 - Phone
- (573) 443-6828
- Fax
- (573) 397-6061
- NPI assigned
- May 18, 2006
- Last updated
- Dec 18, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 01-04975 | KS | |
| Chiropractor | 111N00000X | 2000172546 | MO | Primary |
Addresses
Primary practice location
2503 Bernadette Dr
Columbia, MO 65203
Mailing address
2503 Bernadette Dr
Columbia, MO 65203-4674
Phone (573) 443-6828
Other practice location 1
209 N Church St
Fayette, MO 65248-1403
Phone (660) 248-2482
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 |
|---|---|---|---|
| 01-04975 | KS | MD | Chiropractor |
| 2000172546 | MO | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prange Enterprises Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba The Wellness Way-Columbia
- Chiropractor
- Columbia, MO
- NPI 1699942862
-
dba Prange Intimates
- Durable Medical Equipment & Medical Supplies
- Columbia, MO
- NPI 1700845708
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545091200000",
"number": "1669425070",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2503 BERNADETTE DR",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652034674",
"telephone_number": "573-443-6828",
"fax_number": "573-397-6061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2503 BERNADETTE DR",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "65203",
"telephone_number": "573-443-6828",
"fax_number": "573-397-6061"
}
],
"practiceLocations": [
{
"address_1": "209 N Church St",
"address_purpose": "LOCATION",
"city": "Fayette",
"state": "MO",
"postal_code": "652481403",
"country_code": "US",
"telephone_number": "660-248-2482",
"fax_number": "660-248-2483",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MAXWELL",
"first_name": "JEREMY",
"middle_name": "D.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-18",
"last_updated": "2018-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "KS",
"license": "01-04975",
"primary": false
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MO",
"license": "2000172546",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.