Jackson Chiropractic PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038010337 Issued in IL

Legal business name

JACKSON CHIROPRACTIC PC

Practice address

2912 Crossing Court
Champaign, IL 61822-6163

Phone

(217) 351-7746

Fax

(866) 204-2774

NPI assigned

Mar 7, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Clint Jackson, D.C.NPI 1174569834

Title

President

Phone

(217) 351-7746

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Clint A Jackson, D.C.

  • Chiropractor
  • Champaign, IL
  • NPI 1174569834
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627603200000",
    "number": "1982735536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2912 CROSSING COURT",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618226163",
            "telephone_number": "217-351-7746",
            "fax_number": "662-042-7748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2912 CROSSING COURT",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618226163",
            "telephone_number": "217-351-7746",
            "fax_number": "866-204-2774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2021-07-30",
        "certification_date": "2021-05-04",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CLINT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-351-7746",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038010337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kacy Irwin
• Katherine Lurene Irwin, LSW
• Jessica Chase Islam, OD, MPH, FAAO
• Tiara Ivy
• J a K Enterprises Inc
• Rachel Jackson Green, MSW, LSW
• Ariel Tarnisha Nicole Jackson
• Clint A Jackson, D.C.
• Jennifer Marie Jackson, RDH
• Susan Jackson, LCSW

• Chiropractor in Champaign, IL
• Providers in Champaign, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; 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.