Northeastern Spine and Sport Chiropractic PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

NORTHEASTERN SPINE AND SPORT CHIROPRACTIC PLLC

Practice address

216 N McMorrine St
Elizabeth City, NC 27909-4410

Phone

(252) 580-1231

NPI assigned

Jan 17, 2024

Organization subpart

No

Name

Jonathan OwenNPI 1649905936

Title

Owner/Chiropractor

Phone

(443) 684-0834

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

• Jonathan Michael Owen, DC

  • Chiropractor
  • Elizabeth City, NC
  • NPI 1649905936
  Medicare reassignment NPD Authorized official

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 17, 2024.

{
    "created_epoch": "1705449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705449600000",
    "number": "1780445684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3519 UNION ST",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279097000",
            "telephone_number": "443-684-0834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 N MCMORRINE ST",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279094410",
            "telephone_number": "252-580-1231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN SPINE AND SPORT CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-17",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A",
        "authorized_official_last_name": "OWEN",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "443-684-0834"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Elizabeth City, NC
• Chiropractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; 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.