Jacob Daniel Briegleb, DC
Individual provider Active NPI Chiropractor · Fenton, MO
NPI 1033628441 · NPPES record last updated Jun 26, 2024
Key facts
- NPI
- 1033628441
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2017031981 (MO)
- Practice address
- 560 Old Smizer Mill Rd
Fenton, MO 63026-3538 - Phone
- (636) 492-1528
- Fax
- (314) 597-6565
- NPI assigned
- Sep 28, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Logan College of Chiropractic, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Revival Chiropractic LLC
Practice addresses (Care Compare)
560 Old Smizer Mill Rd
Fenton, MO 63026-3538
Phone (636) 492-1528
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171108003585 | MO | Practitioner - Chiropractic | 6608132576 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles (2 of 4)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Revival Chiropractic LLC | Chiropractor | Current |
Accepting new patients |
| Healthy Healing Chiropractic LLC | Past |
Accepting new patients |
Locations
464 Old Smizer Mill Rd
Fenton, MO 63026
Phone (636) 492-1528
560 Old Smizer Mill Rd
Fenton, MO 63026
Phone (636) 492-1528
Networks
- IA HMO
- IA HMO C-SNP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2017031981 | MO | Yes |
Addresses
Primary practice location
560 Old Smizer Mill Rd
Fenton, MO 63026-3538
Mailing address
560 Old Smizer Mill Rd
Fenton, MO 63026-3538
Phone (636) 492-1528
Other providers in Fenton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.