Breonka Latroya Jackson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

14680 Issued in TX

Practice address

10464 E Northwest Hwy Ste a
Dallas, TX 75238-4608

Phone

(214) 324-5800

Fax

(214) 324-5838

NPI assigned

Feb 5, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Royal Wellness Center PLLC

  • Chiropractor
  • Dallas, TX
  • NPI 1679729073
  NPD (past)

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

{
    "created_epoch": "1612483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612483200000",
    "number": "1992397434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10464 E NORTHWEST HWY STE A",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752384608",
            "telephone_number": "214-324-5800",
            "fax_number": "214-324-5838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10464 E NORTHWEST HWY STE A",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752384608",
            "telephone_number": "214-324-5800",
            "fax_number": "214-324-5838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BREONKA",
        "middle_name": "LATROYA",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-05",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "14680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DIVER'S LICENSE",
            "identifier": "930211324",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "drbre@wellnesswhiterock.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "10464 E Northwest Hwy Ste A",
            "city": "Dallas",
            "state": "TX",
            "country_code": "US",
            "postal_code": "752384608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Anissa Jackson, LCDC
• Anna Jackson, LPC-A
• Ashley Jackson, LCSW
• Ashley Nichole Jackson, LMFT, PCC-A
• Azariah Jackson
• Chayse Jackson, PA-C
• Chelsea Jackson
• Cheryl Ann Jackson
• Christine Jackson, MCD
• Clayton Jackson, MD

• Chiropractor in Dallas, TX
• Providers in Dallas, TX by specialty
• Chiropractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.