100 Chiro Tonnesen
Organization Active NPI Chiropractor · Saint Johns, FL
NPI 1194456319 · NPPES record last updated Jun 20, 2022
Key facts
- NPI
- 1194456319
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- 100 CHIRO TONNESEN
- Practice address
- 2050 Saint Johns Pkwy Ste 107
Saint Johns, FL 32259-4593 - Phone
- (704) 310-1985
- NPI assigned
- Jun 20, 2022
- Organization subpart
- No
Authorized official
- Name
- Dr. Gregory Tonnesen, DC
- Title
- Chiropractor
- Phone
- (704) 310-1985
Practitioners 2
-
Gregory Tonnesen, DC
-
Jasmine Fahrnbauer, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230106002788 | FL | Part B Supplier - Clinic/Group Practice | 4284004219 |
Receives reassigned benefits from 1 practitioner Practice locations: Saint Johns, FL |
National Provider Directory
Locations
2050 Saint Johns Pkwy
Ste 107
St Johns, FL 32259
Phone (704) 310-1985
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | Yes |
Addresses
Primary practice location
2050 Saint Johns Pkwy Ste 107
Saint Johns, FL 32259-4593
Mailing address
2050 Saint Johns Pkwy Ste 107
Saint Johns, FL 32259-4593
Other providers in Saint Johns, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.