Carissa Marie Jaecks, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4599-12 Issued in WI

Practice address

1620 N Shawano St
Ste E
New London, WI 54961-9318

Phone

(920) 982-5533

NPI assigned

Sep 1, 2010

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 names 1

• Mrs. Carissa Marie Jaecks Reese Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1283299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512086400000",
    "number": "1104133867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 EISENHOWER DR",
            "address_2": "STE G",
            "city": "KIMBERLY",
            "state": "WI",
            "postal_code": "541362152",
            "telephone_number": "715-281-4179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 N SHAWANO ST",
            "address_2": "STE E",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549619318",
            "telephone_number": "920-982-5533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAECKS",
        "first_name": "CARISSA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-01",
        "last_updated": "2017-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4599-12",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARISSA",
            "last_name": "REESE",
            "middle_name": "MARIE JAECKS",
            "prefix": "MRS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Kimberly Ileana Jacobs, OTR
• Sherry Lynn Jagiello, OTA
• Deborah Jalling, LAT
• Erika Janssen
• Kathy Jean Jensen, COTA
• James Lee Jernegan, RPH

• Chiropractor in New London, WI
• Providers in New London, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2017; 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.