Individual provider Active NPI

Jeremy T McKelroy, DC

  • Chiropractor
  • Jonesboro, AR
National Provider Identifier
1770667602
Registry record updated Dec 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1566 Issued in AR
Practice address
1000 E Matthews Ave Ste D
Jonesboro, AR 72401-4344
Phone
(870) 802-9355
Fax
(870) 802-1057
NPI assigned
Oct 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 29, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1566 AR Primary

Addresses

Primary practice location

1000 E Matthews Ave Ste D
Jonesboro, AR 72401-4344

Mailing address

1000 E Matthews Ave Ste D
Jonesboro, AR 72401-4344
Phone (870) 802-9355

Other identifiers 1

IdentifierTypeStateIssuer
157358718MedicaidAR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071210000616 AR Practitioner - Chiropractic 3072602275 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1000 E Matthews Ave
Suite D
Jonesboro, AR 72401-4344
Phone (870) 802-9355

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Back in Action of Jonesboro, Inc. Chiropractor CurrentSince Apr 1, 2015 Accepting new patients

Locations

250 Southwest Dr
Jonesboro, AR 72401
Phone (870) 802-9355

1000 E Matthews Ave
Ste D
Jonesboro, AR 72401
Phone (870) 972-8040

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703808000000",
    "number": "1770667602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E MATTHEWS AVE STE D",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014344",
            "telephone_number": "870-802-9355",
            "fax_number": "870-802-1057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E MATTHEWS AVE STE D",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014344",
            "telephone_number": "870-802-9355",
            "fax_number": "870-802-1057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKELROY",
        "first_name": "JEREMY",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AR",
            "license": "1566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157358718",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.