Active NPI
Jenna Brockhuizen
- Chiropractor
- Elmira, NY
National Provider Identifier
1184010928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- F1-0000915
- Practice address
- 635 W Water St
Elmira, NY 14905 - Phone
- (607) 734-4333
- Fax
- (607) 754-0658
- NPI assigned
- Apr 8, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | F1-0000915 | DE | Primary |
Addresses
Primary practice location
635 W Water St
Elmira, NY 14905
Mailing address
1008 N Adams St
Wilmington, DE 19801-1325
Phone (315) 576-4781
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190429000003 | NY | Practitioner - Chiropractic | 3173844685 | Practice locations: Elmira, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- New York Chiropractic College, 2014
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
635 W Water St
Elmira, NY 14905-2409
Phone (607) 734-4333
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F1-0000915 | DE | MD | Chiropractor |
| 013147 | NY | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543363200000",
"number": "1184010928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1008 N ADAMS ST",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198011325",
"telephone_number": "315-576-4781"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "635 W WATER ST",
"city": "ELMIRA",
"state": "NY",
"postal_code": "14905",
"telephone_number": "607-734-4333",
"fax_number": "607-754-0658"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCKHUIZEN",
"first_name": "JENNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-04-08",
"last_updated": "2018-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "DE",
"license": "F1-0000915",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmira, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.