Jeremy Ray Johnson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

16246 Issued in AR

Practice address

4155 N Steele Blvd Ste 10
Fayetteville, AR 72703-5377

Phone

(501) 454-9961

NPI assigned

Mar 4, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• JRJ Family Enterprises LLC

  dba Ozark Valley Chiropractic

  • Chiropractor
  • Bentonville, AR
  • NPI 1043805708
  Authorized official Same address or phone
• Thrive Integrated Health Inc

  • Physical Medicine & Rehabilitation Physician
  • Fayetteville, AR
  • NPI 1962873455

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1583280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583280000000",
    "number": "1801421409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4155 N STEELE BLVD STE 10",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035377",
            "telephone_number": "501-454-9961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4155 N STEELE BLVD STE 10",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035377",
            "telephone_number": "501-454-9961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JEREMY",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-04",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "AR",
            "license": "16246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC LICENSE",
            "identifier": "16246",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drjeremy@thrivear.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4155 N Steele Blvd Ste 10",
            "city": "Fayetteville",
            "state": "AR",
            "country_code": "US",
            "postal_code": "727035377",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Diane McKinney Johnson, M.S.R.D.L.D.
• Evan Michael Johnson, DDS
• Gail R Johnson, DPM
• Hannah Johnson
• Jeffrey William Johnson, MD
• John William Johnson, M.D.
• Kandice E Johnson, RN, CDE
• Kathleen L Johnson, LCSW
• Katie Johnson
• Kaylyn Johnson

• Chiropractor in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Chiropractor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.