Organization Active NPI

John C Smith Jr Inc

  • Chiropractor
  • Ellisville, MO
National Provider Identifier
1689600157
Registry record updated Dec 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
JOHN C SMITH JR INC
Practice address
249 Clarkson Rd
#101
Ellisville, MO 63011-2219
Phone
(636) 256-0707
NPI assigned
Jun 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2023

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

Authorized official

Name
John Smith Jr., DCNPI 1447288071
Title
Owner
Phone
(636) 256-0707

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

249 Clarkson Rd
#101
Ellisville, MO 63011-2219

Mailing address

249 Clarkson Rd # 101
Ellisville, MO 63011-2497
Phone (636) 256-0707

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040524000352 MO Part B Supplier - Clinic/Group Practice 5698766038 Receives reassigned benefits from 4 practitioners
Practice locations: Ellisville, MO

National Provider Directory

National Provider Directory

Locations

249 Clarkson Rd
Ste 101
Ellisville, MO 63011
Phone (636) 256-0707

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703030400000",
    "number": "1689600157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "249 CLARKSON RD # 101",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112497",
            "telephone_number": "636-256-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "249 CLARKSON RD",
            "address_2": "#101",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112219",
            "telephone_number": "636-256-0707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN C SMITH JR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-256-0707",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellisville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.