Jesse D Walden, D.C.

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

01-05054 Issued in KS

Practice address

11652 W. 75 St.
Shawnee, KS 66214

Phone

(913) 825-1235

NPI assigned

Aug 13, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kaminski Pain and Performance Care,P.C.Group PAC ID 9739190828, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kaminski Pain and Performance Care,P.C.

  • Chiropractor
  • Bettendorf, IA
  • NPI 1255381828
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1218585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218585600000",
    "number": "1578719340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11652 W 75TH ST",
            "city": "SHAWNEE",
            "state": "KS",
            "postal_code": "662141372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11652 W. 75 ST.",
            "city": "SHAWNEE",
            "state": "KS",
            "postal_code": "66214",
            "telephone_number": "913-825-1235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDEN",
        "first_name": "JESSE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-13",
        "last_updated": "2008-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "KS",
            "license": "01-05054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Physician Chiropractor in Shawnee, KS
• Providers in Shawnee, KS by specialty
• Sports Physician Chiropractor in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2008; 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.