Individual provider Active NPI

Jenna Ann Ewers, DC

  • Chiropractor
  • Shorewood, IL
National Provider Identifier
1235550641
Registry record updated Feb 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038012568 Issued in IL
Practice address
852 Sharp Dr
Unit J
Shorewood, IL 60404-8843
Phone
(815) 630-4859
Fax
(815) 630-4860
NPI assigned
Jan 2, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038012568 IL Primary

Addresses

Primary practice location

852 Sharp Dr
Unit J
Shorewood, IL 60404-8843

Mailing address

852 Sharp Dr
Unit J
Shorewood, IL 60404-8843
Phone (815) 630-4859

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038012568ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Minor Chiropractic Health Center PC Chiropractor PastSince Jan 19, 2005 Accepting new patients
Dr. Kwon Blue Mountain Wellness Clinic LLC Chiropractor PastSince Oct 1, 2014 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1388620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487635200000",
    "number": "1235550641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "852 SHARP DR",
            "address_2": "UNIT J",
            "city": "SHOREWOOD",
            "state": "IL",
            "postal_code": "604048843",
            "telephone_number": "815-630-4859",
            "fax_number": "815-630-4860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "852 SHARP DR",
            "address_2": "UNIT J",
            "city": "SHOREWOOD",
            "state": "IL",
            "postal_code": "604048843",
            "telephone_number": "815-630-4859",
            "fax_number": "815-630-4860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EWERS",
        "first_name": "JENNA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-02",
        "last_updated": "2017-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038012568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shorewood, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.