Organization Active NPI

Cross Chiropractic Clinic LLC

  • Chiropractor
  • Trenton, MO
National Provider Identifier
1942587092
Registry record updated Nov 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2011030716 Issued in MO
Legal business name
CROSS CHIROPRACTIC CLINIC LLC
Practice address
1200 E 9TH St
Trenton, MO 64683-2626
Phone
(660) 359-4491
NPI assigned
Nov 3, 2011
Last updated
Nov 3, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2011

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

Authorized official

Name
Dr. Ethan Cross, D.C.NPI 1053693309
Title
Chiropractor
Phone
(660) 359-4491

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2011030716 MO Primary

Addresses

Primary practice location

1200 E 9TH St
Trenton, MO 64683-2626

Mailing address

1200 E. 9TH St.
Trenton, MO 64683
Phone (660) 359-4491

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111207000377 MO Part B Supplier - Clinic/Group Practice 3375718133 Receives reassigned benefits from 1 practitioner
Practice locations: Trenton, MO

National Provider Directory

National Provider Directory

Locations

1200 E 9th St
Trenton, MO 64683
Phone (660) 359-4491

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1320278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320278400000",
    "number": "1942587092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 E. 9TH ST.",
            "city": "TRENTON",
            "state": "MO",
            "postal_code": "64683",
            "telephone_number": "660-359-4491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E 9TH ST",
            "city": "TRENTON",
            "state": "MO",
            "postal_code": "646832626",
            "telephone_number": "660-359-4491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSS CHIROPRACTIC CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-03",
        "last_updated": "2011-11-03",
        "status": "A",
        "authorized_official_last_name": "CROSS",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "660-359-4491",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2011030716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trenton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; 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.