Jacob Edward Boll, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHI-CHI-LIC-4595 Issued in MT

Practice address

25 Jefferson River Rd
Three Forks, MT 59752-9765

Phone

(712) 260-0831

NPI assigned

Nov 18, 2016

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pairmore and Young Synergy Chiropractic LLCGroup PAC ID 3678662699, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Pairmore & Young: Synergy Chiropractic LLC

  • Chiropractor
  • Anchorage, AK
  • NPI 1831370527
  Medicare reassignment Care Compare group NPD
• Gallatin Plastic Surgery, PLLC

  • Plastic Surgery Physician
  • Bozeman, MT
  • NPI 1255788592

  Single Specialty

  NPD (past)
• Better Health Alaska

  • Adult Health Nurse Practitioner
  • Anchorage, AK
  • NPI 1043955917

  Single Specialty

  NPD (past)
• White and Associates LLC

  dba Clear Chiropractic

  • Chiropractor
  • Spokane, WA
  • NPI 1043652787
  NPD (past)

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

{
    "created_epoch": "1479427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1861935173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 JEFFERSON RIVER RD",
            "city": "THREE FORKS",
            "state": "MT",
            "postal_code": "597529765",
            "telephone_number": "712-260-0831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 JEFFERSON RIVER RD",
            "city": "THREE FORKS",
            "state": "MT",
            "postal_code": "597529765",
            "telephone_number": "712-260-0831"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2503 E 27th Ave",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992234908",
            "country_code": "US",
            "telephone_number": "509-315-8166",
            "fax_number": "509-315-8308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLL",
        "first_name": "JACOB",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-11-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH60706123",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MT",
            "license": "CHI-CHI-LIC-4595",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1437668449",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 406 RX PLLC (Three Forks Family Pharmacy)
• Bates Family Diversified, LLC (Three Rivers Clinic)
• Jack Howard Berg, D.C.
• Chiro-Kinetics, P.C.
• Chiropractic Clinic of Three Forks
• Clarkston Fire Service Area No 6
• Jennifer Collins
• Jamie Lyn Demaray

• Chiropractor in Three Forks, MT
• Providers in Three Forks, MT by specialty
• Chiropractor in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.