Joseph Jimenez, DC
Individual provider Active NPI Chiropractor · Sandwich, IL
NPI 1609950641 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1609950641
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038009472 (IL)
- Practice address
- 823 E Church St
Sandwich, IL 60548 - Phone
- (815) 786-8191
- Fax
- (815) 786-2097
- NPI assigned
- Oct 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Logan College of Chiropractic, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
823 E Church St
Suite a
Sandwich, IL 60548-1890
Phone (815) 786-8191
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110317000359 | IL | Practitioner - Chiropractic | 5193868164 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038009472 | IL | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Triad Wellness and Performance P C | Chiropractor | Current |
Accepting new patients |
| Weiss Family Chiropractic | Chiropractor | Past | Accepting new patients |
Locations
2035 Bridge Ave
Ste 102
Davenport, IA 52803
Phone (563) 322-2207
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038009472 | IL | Yes |
Addresses
Primary practice location
823 E Church St
Sandwich, IL 60548
Mailing address
823 E Church St PO Box 447
Sandwich, IL 60548
Phone (815) 786-8191
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01930370 | Other | IL | BCBS |
Other providers in Sandwich, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.