Jacksonville Chiropractic Clinic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3206 Issued in OR

Legal business name

JACKSONVILLE CHIROPRACTIC CLINIC LLC

Practice address

580 Blackstone Aly
Jacksonville, OR 97530-9007

Phone

(541) 899-2760

Fax

(541) 899-2760

NPI assigned

Jun 4, 2010

Organization subpart

No

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

Authorized official

Name

Jason Jude Williams, D.C.NPI 1154534121

Title

Clinic Director

Phone

(541) 899-2760

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jason Jude Williams, DC

  • Chiropractor
  • Jacksonville, OR
  • NPI 1154534121
  Medicare reassignment NPD Authorized official
• Justin Geyer, DC

  • Independent Medical Examiner Chiropractor
  • Jacksonville, OR
  • NPI 1932912706
  NPD (past)
• Aalexyz Mychelle Wilkinson, LMT

  • Massage Therapist
  • Medford, OR
  • NPI 1689457780

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1275609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275609600000",
    "number": "1891015483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1077",
            "city": "JACKSONVILLE",
            "state": "OR",
            "postal_code": "975301077",
            "telephone_number": "541-899-2760",
            "fax_number": "541-899-2760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 BLACKSTONE ALY",
            "city": "JACKSONVILLE",
            "state": "OR",
            "postal_code": "975309007",
            "telephone_number": "541-899-2760",
            "fax_number": "541-899-2760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE CHIROPRACTIC CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-04",
        "last_updated": "2010-06-04",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "JUDE",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "541-899-2760",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "3206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "274976",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jacksonville Pharmacy LLC
• Jacksonville Pharmacy, Inc.
• Jacksonville Vision Clinic Inc
• James Kenneth Johnson, R.PH.

• Chiropractor in Jacksonville, OR
• Providers in Jacksonville, OR by specialty
• Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.