Active NPI
Jeffrey M C Wong, D.C.
- Orthopedic Chiropractor
- St Charles, IL
National Provider Identifier
1508866500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Chiropractor
- License
- 038-007475
- Practice address
- 2560 Foxfield Rd
Suite 140
St Charles, IL 60174-1488 - Phone
- (630) 584-8729
- Fax
- (855) 442-7883
- NPI assigned
- Aug 1, 2005
- Reactivated
- Jun 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Orthopedic Chiropractor | 111NX0800X | 038-007475 | IL | Primary |
Addresses
Primary practice location
2560 Foxfield Rd
Suite 140
St Charles, IL 60174-1488
Mailing address
301 Carrie CT
North Aurora, IL 60542-9096
Phone (630) 584-8729
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100301000053 | IL | Practitioner - Chiropractic | 6608911888 | Practice locations: St Charles, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- National College of Chiropractic, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2560 Foxfield Rd
Suite 140
St Charles, IL 60174-1488
Phone (630) 584-8729
301 Carrie CT
North Aurora, IL 60542-9096
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038-007475 | IL | MD | Orthopedic Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434931200000",
"number": "1508866500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 CARRIE CT",
"city": "NORTH AURORA",
"state": "IL",
"postal_code": "605429096",
"telephone_number": "630-584-8729",
"fax_number": "855-442-7883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2560 FOXFIELD RD",
"address_2": "SUITE 140",
"city": "ST CHARLES",
"state": "IL",
"postal_code": "601741488",
"telephone_number": "630-584-8729",
"fax_number": "855-442-7883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "JEFFREY",
"middle_name": "M C",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-01",
"last_updated": "2015-06-22",
"deactivation_date": "2006-03-22",
"reactivation_date": "2006-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "111NX0800X",
"taxonomy_group": "",
"desc": "Chiropractor, Orthopedic",
"state": "IL",
"license": "038-007475",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Charles, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2015; 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.