Jerome Allan Fagerstrom, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3406 Issued in WI

Practice address

654 Bluff St
Beloit, WI 53511-6156

Phone

(608) 362-7652

Fax

(608) 362-7296

NPI assigned

Jul 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chiropractic Care Center, LLC

  • Chiropractor
  • Beloit, WI
  • NPI 1144956467
  NPD (past)

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449705600000",
    "number": "1205852738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "654 BLUFF ST",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535116156",
            "telephone_number": "608-362-7652",
            "fax_number": "608-362-7296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "654 BLUFF ST",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535116156",
            "telephone_number": "608-362-7652",
            "fax_number": "608-362-7296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGERSTROM",
        "first_name": "JEROME",
        "middle_name": "ALLAN",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2015-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38899100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul Erickson, RN
• Tyler James Esser, PT, DPT
• Sheila Evanoff, MS, NCC, LPC-IT
• Samantha L Everson, LCSW
• Eyeworks of Beloit Inc.
• Michelle Falzone
• Family Services of Southern Wisconsin and Northern Illinois
• Dimitrios I Fanopoulos, MD MPH
• Judith Gail Ferko, M.D.
• Angela Fessler, LCSW, CSAC

• Chiropractor in Beloit, WI
• Providers in Beloit, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2015; 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.