DR. JACK D CROCKER (DC) – Chiropractor, NPI 1558321638

DR. JACK D CROCKER (DC) is a healthcare provider. based in Lebanon, Missouri. specializing in CHIROPRACTIC. They hold the professional credentials DC. They hold a License No. 004819 (MO). The NPI Number for DR. JACK D CROCKER (DC) is 1558321638

Main info

Male
43 Years Of Experience
Accepts Medicare Assignment
Name
DR. JACK D CROCKER (DC)
NPI
1558321638
Phone
(417) 532-9166
Address
464 N JEFFERSON AVE
Enumeration Date
24 March 2006
Last Update Date
2 May 2014

Doctor Profile

Medical School Name
LOGAN COLLEGE OF CHIROPRACTIC
Secondary Phone
4175329166
Graduation Year
1983 (43 years ago)
PAC ID
2466619739
Professional Enrollment ID
I20120130000569
Address ID
MO655362742LE464XXAVEX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:20State licenses:1Digital endpointsOther names

1,129 CHIROPRACTIC in MO

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Provider Addresses for DR. JACK D CROCKER (DC)

  • 464, North Jefferson Avenue, Lebanon, Laclede County, Missouri, 65536, United States

    LEBANON, MO 655362742

    Phone: (417) 532-9166

    Fax: (417) 532-9887

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2012-01-30

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20120130000569IChiropracticMOTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
98940Chiropractic manipulative treatment, 1-2 spinal regions13515$0
View full utilization report →

Insurance plans in this area (ZIP 65536)

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Provider's Procedures

DR. JACK D CROCKER (DC) performs procedures in CHIROPRACTIC. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
CHIROPRACTICMO98940Chiropractic manipulative treatment, 1-2 spinal regions39638

Reviews

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Frequently asked questions

What federal number belongs to DR. JACK D CROCKER (DC)?
The federal identifier for DR. JACK D CROCKER (DC) is NPI 1558321638.
Is DR. JACK D CROCKER (DC)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What field does DR. JACK D CROCKER (DC) work in?
You can think of DR. JACK D CROCKER (DC) as practicing within Chiropractor. Clinical services aligned with this taxonomy classification.
Where is DR. JACK D CROCKER (DC)'s primary listing?
We display Lebanon, Missouri because that is what the record indicates for DR. JACK D CROCKER (DC).
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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