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

Last updated

Jan 17, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jonathan OwenNPI 1649905936

Title

Owner/Chiropractor

Phone

(443) 684-0834

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jonathan Michael Owen, DC

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

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

{
    "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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• Chiropractor in Elizabeth City, NC
• Providers in Elizabeth City, NC by specialty
• 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.