NPIMap

Organization Active NPI

Lightsource Chiropractic, LLC

  • Chiropractor
  • Clinton, NJ
National Provider Identifier
1679023154
Registry record updated Oct 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
MC05797 Issued in NJ
Legal business name
LIGHTSOURCE CHIROPRACTIC, LLC
Practice address
6 East Main Street
Suite 6
Clinton, NJ 08809
Phone
(908) 399-3499
NPI assigned
Oct 10, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2016

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

Authorized official

Name
Dr. Jodi Nichole Dinnerman, DC
Title
Owner
Phone
(908) 399-3499

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X MC05797 NJ Primary

Addresses

Primary practice location

6 East Main Street
Suite 6
Clinton, NJ 08809

Mailing address

6 East Main Street
Suite 6
Clinton, NJ 08809
Phone (908) 399-3499

National Provider Directory

National Provider Directory
Tax ID family
Lightsource Chiropractic LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6 E Main St
Ste 6
Clinton, NJ 08809
Phone (908) 399-1919

NPI Registry JSON

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

{
    "created_epoch": "1476057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1679023154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 EAST MAIN STREET",
            "address_2": "SUITE 6",
            "city": "CLINTON",
            "state": "NJ",
            "postal_code": "08809",
            "telephone_number": "908-399-3499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 EAST MAIN STREET",
            "address_2": "SUITE 6",
            "city": "CLINTON",
            "state": "NJ",
            "postal_code": "08809",
            "telephone_number": "908-399-3499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTSOURCE CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-10",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "DINNERMAN",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "NICHOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-399-3499",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "MC05797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.