Active NPI
Jay P Mulligan Jr., DC
- Chiropractor
- Saint Louis, MO
National Provider Identifier
1811981707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 005086
- Practice address
- 11872 Gravois Rd
Saint Louis, MO 63127-1800 - Phone
- (314) 849-3040
- Fax
- (314) 849-7279
- NPI assigned
- Sep 7, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 005086 | MO | Primary |
| Chiropractor | 111N00000X | 1550 | NC | |
| Chiropractor | 111N00000X | 5684 | FL |
Addresses
Primary practice location
11872 Gravois Rd
Saint Louis, MO 63127-1800
Mailing address
11872 Gravois Rd
Saint Louis, MO 63127-1800
Phone (314) 849-3040
Other identifiers 18
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 250010 | Other | MO | ASHN |
| 5086 | Other | ALL | |
| 1329576 | Other | PRINCIPAL HEALTH CARE | |
| 3082849 | Other | CIGNA | |
| 5224 | Other | BCBS ALLIANCE | |
| 3082849 | Other | AMERICAN SPECIALTY HEALTH | |
| 250888 | Other | MO | ACN |
| 000000010306 | Other | ESSENCE HEALTHCARE | |
| 177379 | Other | HEALTHLINK PPO | |
| 177379 | Other | HEALTHLINK HMO | |
| 140968 | Other | MO | GHP |
| 4218073 | Other | AETNA | |
| 4218073 | Other | AETNA US HEALTHCARE | |
| 177379 | Other | CARPENTERS HL | |
| 4400465 | Other | MEDICARE COMPLETE | |
| 5224 | Other | BLUE CHOICE | |
| 350057134 | Other | MO | RAILROAD MEDICARE |
| 4400465 | Other | UNITED HEALTHCARE |
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 |
|---|---|---|---|
| 1550 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| 5684 | FL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208217600000",
"number": "1811981707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11872 GRAVOIS RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631271800",
"telephone_number": "314-849-3040",
"fax_number": "314-849-7279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11872 GRAVOIS RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631271800",
"telephone_number": "314-849-3040",
"fax_number": "314-849-7279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLIGAN",
"first_name": "JAY",
"middle_name": "P",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-07",
"last_updated": "2008-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MO",
"license": "005086",
"primary": true
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NC",
"license": "1550",
"primary": false
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "5684",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASHN",
"identifier": "250010",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALL",
"identifier": "5086",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRINCIPAL HEALTH CARE",
"identifier": "1329576",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "3082849",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS ALLIANCE",
"identifier": "5224",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN SPECIALTY HEALTH",
"identifier": "3082849",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ACN",
"identifier": "250888",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ESSENCE HEALTHCARE",
"identifier": "000000010306",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK PPO",
"identifier": "177379",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK HMO",
"identifier": "177379",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHP",
"identifier": "140968",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4218073",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA US HEALTHCARE",
"identifier": "4218073",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARPENTERS HL",
"identifier": "177379",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE COMPLETE",
"identifier": "4400465",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHOICE",
"identifier": "5224",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "350057134",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "4400465",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.