Individual provider Active NPI

Jeffrey Lee Nagle, D.C.

  • Sports Physician Chiropractor
  • Sikeston, MO
National Provider Identifier
1861512576
Registry record updated Dec 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
5752 Issued in MO
Practice address
808 E Wakefield Ave
Suite a
Sikeston, MO 63801-5147
Phone
(573) 472-4470
Fax
(573) 472-4139
NPI assigned
Mar 29, 2007
Last updated
Dec 17, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician Chiropractor 111NS0005X 5752 MO Primary

Addresses

Primary practice location

808 E Wakefield Ave
Suite a
Sikeston, MO 63801-5147

Mailing address

808 E Wakefield Ave
Suite a
Sikeston, MO 63801-5147
Phone (573) 472-4470

Other identifiers 4

IdentifierTypeStateIssuer
189386OtherMOHEALTHLINK
44-01193OtherMOUNITED HEALT CARE
350025205OtherRR MEDICARE PALMENTO
106378OtherMOBCBS

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

LicenseStateTypeSpecialty
5752MOMDSports Physician Chiropractor

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450310400000",
    "number": "1861512576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 E WAKEFIELD AVE",
            "address_2": "SUITE A",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638015147",
            "telephone_number": "573-472-4470",
            "fax_number": "573-472-4139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 E WAKEFIELD AVE",
            "address_2": "SUITE A",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638015147",
            "telephone_number": "573-472-4470",
            "fax_number": "573-472-4139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAGLE",
        "first_name": "JEFFREY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-29",
        "last_updated": "2015-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "MO",
            "license": "5752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "189386",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALT CARE",
            "identifier": "44-01193",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PALMENTO",
            "identifier": "350025205",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "106378",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sikeston, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2015; 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.