Active NPI
Jonathan Eric Main, DC
- Chiropractor
- Meridian, ID
National Provider Identifier
1790810380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CHIA-991
- Practice address
- 2300 W Everest LN
Suite #175
Meridian, ID 83646-5925 - Phone
- (208) 895-0858
- Fax
- (208) 895-0561
- NPI assigned
- Feb 22, 2007
- Sex
- Male
- Sole proprietor
- No
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 | CHIA-991 | ID | Primary |
Addresses
Primary practice location
2300 W Everest LN
Suite #175
Meridian, ID 83646-5925
Mailing address
2300 W Everest LN
Suite #175
Meridian, ID 83646-5925
Phone (208) 895-0858
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C3167 | Other | ID | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHIA-991 | ID | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Full Life Chiropractic, PA | Chiropractor | Past | Accepting new patients |
| One Life Chiropractic | Chiropractor | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Chiropractor
- Caldwell, ID
- NPI 1447483516
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292803200000",
"number": "1790810380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 W EVEREST LN",
"address_2": "SUITE #175",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836465925",
"telephone_number": "208-895-0858",
"fax_number": "208-895-0561"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 W EVEREST LN",
"address_2": "SUITE #175",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836465925",
"telephone_number": "208-895-0858",
"fax_number": "208-895-0561"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAIN",
"first_name": "JONATHAN",
"middle_name": "ERIC",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-22",
"last_updated": "2010-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "ID",
"license": "CHIA-991",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "C3167",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.