NPIMap

Organization Active NPI

Ennis Straight Chiropractic Center

  • Chiropractor
  • State College, PA
National Provider Identifier
1235780909
Registry record updated Oct 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
ENNIS STRAIGHT CHIROPRACTIC CENTER
Practice address
1526 N Atherton St Ste 200
State College, PA 16803-3041
Phone
(814) 237-5220
Fax
(412) 291-3381
NPI assigned
Sep 24, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2019

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

Authorized official

Name
Dr. Bradley D Ennis, DCNPI 1699886390
Title
Provider
Phone
(814) 404-4046

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

1526 N Atherton St Ste 200
State College, PA 16803-3041

Mailing address

1526 N Atherton St Ste 200
State College, PA 16803-3041
Phone (814) 353-1217

Other identifiers 2

IdentifierTypeStateIssuer
347952OtherPABCBS
03081900OtherPACAPITAL BCBS

Other names 1

  • Bradley D. Ennis,DC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191017000090 PA Part B Supplier - Clinic/Group Practice 7911238233 Receives reassigned benefits from 1 practitioner
Practice locations: State College, PA

National Provider Directory

National Provider Directory

Locations

1526 N Atherton St
#200
State College, PA 16803
Phone (814) 237-5220

Practitioners & affiliated clinicians

Practitioners 5

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": "1569283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571011200000",
    "number": "1235780909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1526 N ATHERTON ST STE 200",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168033041",
            "telephone_number": "814-353-1217",
            "fax_number": "412-291-3381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 N ATHERTON ST STE 200",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168033041",
            "telephone_number": "814-237-5220",
            "fax_number": "412-291-3381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENNIS STRAIGHT CHIROPRACTIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-24",
        "last_updated": "2019-10-14",
        "status": "A",
        "authorized_official_last_name": "ENNIS",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "814-404-4046",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "347952",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BCBS",
            "identifier": "03081900",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bradley D. Ennis,DC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Bradley D. Ennis,DC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in State College, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.