Active NPI
Marvin Zebedee Jackson Jr., B.S.,D.C.
- Chiropractor
- Forest Park, IL
National Provider Identifier
1891957015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 038-011180
- Practice address
- 7435 Madison St
Forest Park, IL 60130-1542 - Phone
- (312) 998-8282
- NPI assigned
- Jun 29, 2008
- 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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038-011180 | IL | Primary |
Addresses
Primary practice location
7435 Madison St
Forest Park, IL 60130-1542
Mailing address
7435 Madison St
Forest Park, IL 60130-1542
Phone (312) 998-8282
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080926000257 | IL | Practitioner - Chiropractic | 8628145083 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038-011180 | IL | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rhicc,LLC | Past | Accepting new patients | |
| Reflections of Health Integrative Care Center, LLC | Chiropractor | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Chiropractor
- Chicago, IL
- NPI 1710120647
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583366400000",
"number": "1891957015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7435 MADISON ST",
"city": "FOREST PARK",
"state": "IL",
"postal_code": "601301542",
"telephone_number": "312-998-8282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7435 MADISON ST",
"city": "FOREST PARK",
"state": "IL",
"postal_code": "601301542",
"telephone_number": "312-998-8282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MARVIN",
"middle_name": "ZEBEDEE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "B.S.,D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-29",
"last_updated": "2020-03-05",
"certification_date": "2020-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IL",
"license": "038-011180",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Park, IL
- Huma Hussain, OD
- Illinois Behavior Analysis Group, LLC
- Illinois Dental Providers (Harlem & North), LTD. (DentalWorks of Forest Park)
- Isa's Creative Counseling
- Jessica Jacknow
- Karen Janiec, NP
- Jayreese Transportation Service
- Debra L Jensen, L. AC.
- Jerry E Udelson, DDS, PC (Little Teeth Big Smiles & Children's Dentistry)
- Jin Wu PSYD LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; 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.