Jesse Boelter, D.C.
Individual provider Active NPI Chiropractor · Sycamore, IL
NPI 1497110902 · NPPES record last updated Dec 28, 2015
Key facts
- NPI
- 1497110902
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038.012502 (IL)
- Practice address
- 1680 Mediterranean Dr
Sycamore, IL 60178-3154 - Phone
- (815) 899-6061
- NPI assigned
- Dec 28, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Healthsource of Plainfield LTD
Practice addresses (Care Compare)
24020 W Riverwalk CT
Suite 116
Plainfield, IL 60544-7122
Phone (815) 782-7097
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180130000690 | IL | Practitioner - Chiropractic | 1153681747 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038.012502 | IL | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthsource of Plainfield LTD | Chiropractor | Current |
Accepting new patients |
Locations
24020 W Riverwalk Ct
Ste 116
Plainfield, IL 60544
Phone (815) 782-7097
24020 W Riverwalk Ct
Ste 118
Plainfield, IL 60544
Phone (815) 782-7097
24020 W Riverwalk Ct
Plainfield, IL 60544
Phone (815) 345-5292
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038.012502 | IL | Yes |
Addresses
Primary practice location
1680 Mediterranean Dr
Sycamore, IL 60178-3154
Mailing address
1680 Mediterranean Dr
Sycamore, IL 60178-3154
Phone (815) 899-6061
Other providers in Sycamore, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.