Timothy John Zackery, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2020043237 Issued in MO

Practice address

1934 S Glenstone Ave
Springfield, MO 65804-2305

Phone

(417) 887-0340

Fax

(417) 887-0445

NPI assigned

Jan 4, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Specialty

Chiropractic

Education

Logan College of Chiropractic, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

180 Health Lifestyle Wellness CentersGroup PAC ID 1052747888, 6 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• 180 Health Lifestyle Wellness Centers

  • Chiropractor
  • Springfield, MO
  • NPI 1952467797

  MO

  Medicare reassignment Care Compare group
• 180 Health Lifestyle Wellness Centers

  • General Practice Physician
  • Springfield, MO
  • NPI 1649815796
  NPD (past)

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

{
    "created_epoch": "1609718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1881282010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1934 S GLENSTONE AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042305",
            "telephone_number": "417-887-0340",
            "fax_number": "417-887-0445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1934 S GLENSTONE AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042305",
            "telephone_number": "417-887-0340",
            "fax_number": "417-887-0445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZACKERY",
        "first_name": "TIMOTHY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-04",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2020043237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Springfield, MO
• Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; 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.