NPIMap

Organization Active NPI

Ravenswood Health Center, P.C.

  • Chiropractor
  • Chicago, IL
National Provider Identifier
1114116522
Registry record updated Dec 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-008864 Issued in IL
Legal business name
RAVENSWOOD HEALTH CENTER, P.C.
Practice address
4256 N. Ravenswood Ave.
Suite Number 101
Chicago, IL 60613
Phone
(773) 327-2225
Fax
(773) 327-7554
NPI assigned
Oct 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2014

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

Authorized official

Name
Dr. Jason G. Fennema, D.C.NPI 1386657690
Title
Owner/President
Phone
(773) 327-2225

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 038-008864 IL Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 070009516 IL

Addresses

Primary practice location

4256 N. Ravenswood Ave.
Suite Number 101
Chicago, IL 60613

Mailing address

4256 N. Ravenswood Ave,
Suite Number 101
Chicago, IL 60613
Phone (773) 327-2225

National Provider Directory

National Provider Directory

Locations

4256 N Ravenswood Ave
Chicago, IL 60613
Phone (312) 399-3284

4256 N Ravenswood Ave
#101
Chicago, IL 60613
Phone (773) 327-2225

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419897600000",
    "number": "1114116522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4256 N. RAVENSWOOD AVE,",
            "address_2": "SUITE NUMBER 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60613",
            "telephone_number": "773-327-2225",
            "fax_number": "773-327-7554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4256 N. RAVENSWOOD AVE.",
            "address_2": "SUITE NUMBER 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60613",
            "telephone_number": "773-327-2225",
            "fax_number": "773-327-7554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAVENSWOOD HEALTH CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-22",
        "last_updated": "2014-12-30",
        "status": "A",
        "authorized_official_last_name": "FENNEMA",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "773-327-2225",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-008864",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070009516",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2014; 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.