Active NPI
Johnny Allen Colegrove, DC
- Chiropractor
- Mineola, TX
National Provider Identifier
1902999113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 4217
- Practice address
- 1044 N Pacific
Mineola, TX 75773 - Phone
- (903) 569-6261
- Fax
- (903) 569-1792
- NPI assigned
- Oct 2, 2006
- Last updated
- Jul 27, 2010
- Sex
- Male
- Sole proprietor
- No
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 | 4217 | TX | Primary |
Addresses
Primary practice location
1044 N Pacific
Mineola, TX 75773
Mailing address
1044 N Pacific
Mineola, TX 75773
Phone (903) 569-6261
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001341901 | Medicaid | TX | |
| 601744 | Other | TX | BCBS |
| 5676121 | Other | TX | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040706000225 | TX | Practitioner - Chiropractic | 2567449853 | Practice locations: Mineola, TX |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Other, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1044 N Pacific St
Mineola, TX 75773-1838
Phone (903) 569-6261
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280188800000",
"number": "1902999113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1044 N PACIFIC",
"city": "MINEOLA",
"state": "TX",
"postal_code": "75773",
"telephone_number": "903-569-6261",
"fax_number": "903-569-1792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1044 N PACIFIC",
"city": "MINEOLA",
"state": "TX",
"postal_code": "75773",
"telephone_number": "903-569-6261",
"fax_number": "903-569-1792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLEGROVE",
"first_name": "JOHNNY",
"middle_name": "ALLEN",
"name_prefix": "Mr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2010-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "TX",
"license": "4217",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001341901",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "601744",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5676121",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mineola, TX
- Christus Trinity Clinic
- Christus Trinity Clinic Texas (Trinity Clinic Mineola)
- City of Ennis (Wood Memorial Nursing and Rehabilitation Center)
- Dan Clarkson
- Cindy Sue Cole, LVN
- Taylor Renea Craver
- CVS Pharmacy Inc (CVS Pharmacy #10340)
- Henry Clay Davis, LICENSED PROFESSIONA
- Dehaven Optical Center
- Diana Bankhead MD PLLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2010; 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.