Individual provider Active NPI

Jennifer Gwen Johnson, D.C.

  • Chiropractor
  • Butte, MT
National Provider Identifier
1386878676
Registry record updated Dec 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHI-CHI-LIC-1188 Issued in MT
Practice address
31 W Park St
Butte, MT 59701-1713
Phone
(406) 565-3760
NPI assigned
May 14, 2009
Last updated
Dec 19, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 19, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 9178 AZ
Chiropractor 111N00000X 1188 MT
Chiropractor 111N00000X CHI-CHI-LIC-1188 MT Primary

Addresses

Primary practice location

31 W Park St
Butte, MT 59701-1713

Mailing address

1117 W Galena St
Butte, MT 59701-1421
Phone (406) 565-3760

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL kareo Other

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100204000118 MT Practitioner - Chiropractic 7618010273 Reassigns benefits to 2 organizations
Practice locations: Butte, MT

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2008
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

300 W Mercury St
Butte, MT 59701-1652
Phone (406) 565-3760

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9178AZMDChiropractor
1188MTMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Joint Action PLLC Chiropractor CurrentSince Nov 1, 2022 Accepting new patients
Advanced Spinal Fitness Chiropractic PLLC Chiropractor PastSince Nov 2, 2012 Accepting new patients

Locations

31 W Park St
Butte, MT 59701
Phone (406) 565-3760

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1242259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671408000000",
    "number": "1386878676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1117 W GALENA ST",
            "city": "BUTTE",
            "state": "MT",
            "postal_code": "597011421",
            "telephone_number": "406-565-3760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 W PARK ST",
            "city": "BUTTE",
            "state": "MT",
            "postal_code": "597011713",
            "telephone_number": "406-565-3760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JENNIFER",
        "middle_name": "GWEN",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-14",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "9178",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MT",
            "license": "1188",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MT",
            "license": "CHI-CHI-LIC-1188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "kareo",
            "affiliation": "N",
            "endpointDescription": "software",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "n/a",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "n/a",
            "address_1": "31 W Park St",
            "city": "Butte",
            "state": "MT",
            "country_code": "US",
            "postal_code": "597011713",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Butte, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.