Active NPI
Jaclyn Kelly Cooper-Henson, DC
- Chiropractor
- Columbia, KY
National Provider Identifier
1699730614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 4655
- Practice address
- 117 Merchant St
Columbia, KY 42728 - Phone
- (270) 384-5772
- Fax
- (270) 380-1778
- NPI assigned
- Apr 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | 4655 | KY | Primary |
Addresses
Primary practice location
117 Merchant St
Columbia, KY 42728
Mailing address
117 Merchant St
PO Box 861
Columbia, KY 42728
Phone (270) 384-5772
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 85001881 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040223000699 | KY | Practitioner - Chiropractic | 9335035815 | Practice locations: Columbia, KY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4655 | KY | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355270400000",
"number": "1699730614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 MERCHANT ST",
"address_2": "PO BOX 861",
"city": "COLUMBIA",
"state": "KY",
"postal_code": "42728",
"telephone_number": "270-384-5772",
"fax_number": "270-380-1778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 MERCHANT ST",
"city": "COLUMBIA",
"state": "KY",
"postal_code": "42728",
"telephone_number": "270-384-5772",
"fax_number": "270-380-1778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOPER-HENSON",
"first_name": "JACLYN",
"middle_name": "KELLY",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-20",
"last_updated": "2012-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "KY",
"license": "4655",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "85001881",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2012; 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.