NPIMap

Organization Active NPI

JLB,Inc

Doing business as Fontana Family Chiropractic

  • Chiropractor
  • Fontana, WI
National Provider Identifier
1306045315
Registry record updated Dec 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4188-012 Issued in WI
Legal business name
JLB,INC
Doing business as
Fontana Family Chiropractic
Practice address
450 Mill St
Suite 102
Fontana, WI 53125-1242
Phone
(262) 275-5005
NPI assigned
Jul 11, 2007
Last updated
Dec 30, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2013

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

Authorized official

Name
Dr. Jeremy Logan Bria, D.C.NPI 1669531885
Title
Chiropractor
Phone
(262) 325-7195

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
Chiropractor 111N00000X 4188-012 WI Primary

Addresses

Primary practice location

450 Mill St
Suite 102
Fontana, WI 53125-1242

Mailing address

450 Mill St
Suite 102
Fontana, WI 53125-1242
Phone (262) 275-5005

Other identifiers 2

IdentifierTypeStateIssuer
38966200MedicaidWI
000054027OtherMEDICARE

Other names 1

  • Fontana Family Chiropractic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060309000671 WI Part B Supplier - Clinic/Group Practice 2860409208 Receives reassigned benefits from 2 practitioners
Practice locations: Fontana, WI

National Provider Directory

National Provider Directory

Locations

450 Mill St
#102
Fontana, WI 53125
Phone (262) 275-5005

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1184112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388361600000",
    "number": "1306045315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 MILL ST",
            "address_2": "SUITE 102",
            "city": "FONTANA",
            "state": "WI",
            "postal_code": "531251242",
            "telephone_number": "262-275-5005",
            "fax_number": "262-275-5004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 MILL ST",
            "address_2": "SUITE 102",
            "city": "FONTANA",
            "state": "WI",
            "postal_code": "531251242",
            "telephone_number": "262-275-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JLB,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-11",
        "last_updated": "2013-12-30",
        "status": "A",
        "authorized_official_last_name": "BRIA",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "LOGAN",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "262-325-7195",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4188-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38966200",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "000054027",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fontana Family Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fontana, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2013; 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.