NPIMap

Organization Active NPI

Jenifer L. Dewald, DC PC

  • Chiropractor
  • Williamsport, PA
National Provider Identifier
1669403804
Registry record updated Jul 25, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
JENIFER L. DEWALD, DC PC
Practice address
1355 Four Mile Dr
Williamsport, PA 17701-1932
Phone
(570) 322-1776
Fax
(570) 322-1774
NPI assigned
Jul 5, 2006
Last updated
Jul 25, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2007

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

Authorized official

Name
Dr. Jenifer Lynn Dewald, DO
Title
President
Phone
(570) 322-1776

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X Primary

Addresses

Primary practice location

1355 Four Mile Dr
Williamsport, PA 17701-1932

Mailing address

1355 Four Mile Dr
Williamsport, PA 17701-1932
Phone (570) 322-1776

Other identifiers 1

IdentifierTypeStateIssuer
0017404480002MedicaidPA

National Provider Directory

National Provider Directory

Locations

1961 W 4th St
Williamsport, PA 17701
Phone (570) 322-1776

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185321600000",
    "number": "1669403804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 FOUR MILE DR",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011932",
            "telephone_number": "570-322-1776",
            "fax_number": "570-322-1774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 FOUR MILE DR",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011932",
            "telephone_number": "570-322-1776",
            "fax_number": "570-322-1774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENIFER L. DEWALD, DC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-07-25",
        "status": "A",
        "authorized_official_last_name": "DEWALD",
        "authorized_official_first_name": "JENIFER",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-322-1776",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017404480002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsport, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.