122 Chiropractic Corp.

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

122 CHIROPRACTIC CORP.

Practice address

13850 Booker T Washington Hwy
Moneta, VA 24121-6205

Phone

(941) 713-1392

NPI assigned

Nov 2, 2020

Last updated

Nov 2, 2020By 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

Dr. Samantha Jordan, DC

Title

Chiropractor/Owner

Phone

(941) 713-1392

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 2

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.

• Robert Gump IV, DC

  • Chiropractor
  • Moneta, VA
  • NPI 1871269209
  Medicare reassignment Care Compare group NPD
• Samantha Gump, DC

  • Chiropractor
  • Moneta, VA
  • NPI 1407311533
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1604275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604275200000",
    "number": "1831790351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13850 BOOKER T WASHINGTON HWY",
            "city": "MONETA",
            "state": "VA",
            "postal_code": "241216205",
            "telephone_number": "941-713-1392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13850 BOOKER T WASHINGTON HWY",
            "city": "MONETA",
            "state": "VA",
            "postal_code": "241216205",
            "telephone_number": "941-713-1392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "122 CHIROPRACTIC CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-02",
        "last_updated": "2020-11-02",
        "certification_date": "2020-10-21",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "CHIROPRACTOR/OWNER",
        "authorized_official_telephone_number": "941-713-1392",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sawyer Agnew
• Beacon Counseling Group
• Linda S Beahm, M.D.
• Susan Edwards Beatty, M.D.
• Better Care Pharmacy LLC (Moneta Pharmacy)

• Chiropractor in Moneta, VA
• Providers in Moneta, VA by specialty
• Chiropractor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; 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.