James D Victory, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

980 Issued in MS

Practice address

315 Highway 90
Gautier, MS 39553

Phone

(228) 497-9907

Fax

(228) 497-9917

NPI assigned

Oct 5, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Specialty

Chiropractic

Education

Life Chiropractic College, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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.

• Victory Chiropractic Center

  • Chiropractor
  • Gautier, MS
  • NPI 1447494950
  NPD (past) Authorized official

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535500800000",
    "number": "1881781631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 760",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "39553",
            "telephone_number": "228-497-9907",
            "fax_number": "228-497-9917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 HIGHWAY 90",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "39553",
            "telephone_number": "228-497-9907",
            "fax_number": "228-497-9917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICTORY",
        "first_name": "JAMES",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2018-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MS",
            "license": "980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID #",
            "identifier": "64-0931880",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00123096",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FRIST HEALTH PROVIDER #",
            "identifier": "1866765",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE PROVIDE",
            "identifier": "645632",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER #",
            "identifier": "7614197",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08755862",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Rose Ussery
• Makenzie Lin Vangorder, B.A.
• Addison Daniel Vernon, B.A.
• Anne Margaret Vicini, M.S.
• Victory Chiropractic Center
• Jared Victory
• Ruth Marie Villafane, B.S.
• Jeannie Melissa Walborn, BS
• Marina K Waldrop
• Walgreen Co (Walgreens # 10360)

• Chiropractor in Gautier, MS
• Providers in Gautier, MS by specialty
• Chiropractor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2018; 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.