Active NPI
Jack Percy Dillender II, LMT
- Massage Therapist
- Columbia, MO
National Provider Identifier
1881828762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 2002028196
- Practice address
- 709 Manor Dr
Columbia, MO 65203-1737 - Phone
- (573) 814-1418
- NPI assigned
- May 7, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 2002028196 | MO | Primary |
Addresses
Primary practice location
709 Manor Dr
Columbia, MO 65203-1737
Mailing address
709 Manor Dr
2101Corona Road #201
Columbia, MO 65203-1737
Phone (573) 814-1418
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2002028196 | Other | MO | MASSAGE THERAPY |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2002028196 | MO | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241654400000",
"number": "1881828762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "709 MANOR DR",
"address_2": "2101CORONA ROAD #201",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652031737",
"telephone_number": "573-814-1418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "709 MANOR DR",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652031737",
"telephone_number": "573-814-1418"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DILLENDER",
"first_name": "JACK",
"middle_name": "PERCY",
"name_prefix": "Mr.",
"name_suffix": "II",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-07",
"last_updated": "2009-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MO",
"license": "2002028196",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASSAGE THERAPY",
"identifier": "2002028196",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.