Individual provider Active NPI

Jennifer Chelsie Demaio, DC

  • Chiropractor
  • Port Orange, FL
National Provider Identifier
1639654387
Registry record updated Nov 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH12597 Issued in FL
Practice address
4550 Clyde Morris Blvd
Ste D
Port Orange, FL 32129-4080
Phone
(941) 504-2257
NPI assigned
Sep 28, 2018
Last updated
Nov 1, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH12597 FL Primary

Addresses

Primary practice location

4550 Clyde Morris Blvd
Ste D
Port Orange, FL 32129-4080

Mailing address

4550 Clyde Morris Blvd
Ste D
Port Orange, FL 32129-4080
Phone (941) 504-2257

Other practice location 1

4550 Clyde Morris Blvd
Ste D
Port Orange, FL 32129-4080
Phone (941) 504-2257

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190308001834 FL Practitioner - Chiropractic 2668711623 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4550 Clyde Morris Blvd
Suite D
Port Orange, FL 32129-4080
Phone (386) 238-9355

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal City Chiropractic Center LLC Chiropractor CurrentSince Oct 1, 2018 Accepting new patients

Locations

4550 Clyde Morris Blvd
Ste D
Port Orange, FL 32129
Phone (386) 238-9355

Organizations & group practices 1

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": "1538092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541030400000",
    "number": "1639654387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 CLYDE MORRIS BLVD",
            "address_2": "STE D",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321294080",
            "telephone_number": "941-504-2257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 CLYDE MORRIS BLVD",
            "address_2": "STE D",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321294080",
            "telephone_number": "941-504-2257"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4550 CLYDE MORRIS BLVD",
            "address_2": "STE D",
            "address_purpose": "LOCATION",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321294080",
            "country_code": "US",
            "telephone_number": "941-504-2257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEMAIO",
        "first_name": "JENNIFER",
        "middle_name": "CHELSIE",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-28",
        "last_updated": "2018-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH12597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2018; 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.