Active NPI
Jonathan W Deitz, D.C.
- Chiropractor
- Fargo, ND
National Provider Identifier
1306961768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 682
- Practice address
- 4325 13TH Ave S
Suite 5
Fargo, ND 58103-3341 - Phone
- (701) 212-1419
- NPI assigned
- Mar 21, 2007
- Last updated
- Sep 10, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 682 | ND | Primary |
Addresses
Primary practice location
4325 13TH Ave S
Suite 5
Fargo, ND 58103-3341
Mailing address
4325 13TH Ave S
Suite 5
Fargo, ND 58103-3341
Phone (701) 212-1419
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11334 | Medicaid | ND | |
| 19091 | Other | ND | BCBS OF ND PROVIDER # |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 514 | ND | MD | Social Worker |
| 682 | ND | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| All Seasons Full Body Chiropractic Center LLC | Chiropractor | Past | Accepting new patients |
| Jonathan Chiropractic PC | Chiropractor | Past | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba All Seasons Integrative Health
- Chiropractor
- Fargo, ND
- NPI 1245526201
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378771200000",
"number": "1306961768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4325 13TH AVE S",
"address_2": "SUITE 5",
"city": "FARGO",
"state": "ND",
"postal_code": "581033341",
"telephone_number": "701-212-1419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4325 13TH AVE S",
"address_2": "SUITE 5",
"city": "FARGO",
"state": "ND",
"postal_code": "581033341",
"telephone_number": "701-212-1419"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEITZ",
"first_name": "JONATHAN",
"middle_name": "W",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-21",
"last_updated": "2013-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "ND",
"license": "682",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "11334",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF ND PROVIDER #",
"identifier": "19091",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.