Active NPI
Jeremy L Bria, DC
- Chiropractor
- Fontana, WI
National Provider Identifier
1669531885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 4188-012
- Practice address
- 450 Mill St
Suite 102
Fontana, WI 53125-1242 - Phone
- (262) 275-5005
- Fax
- (262) 275-5004
- NPI assigned
- Dec 6, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 4188-012 | WI | Primary |
Addresses
Primary practice location
450 Mill St
Suite 102
Fontana, WI 53125-1242
Mailing address
450 Mill St
Suite 102
Fontana, WI 53125-1242
Phone (262) 275-5005
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38966200 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
450 Mill St
Suite 102
Fontana, WI 53125-1242
Phone (262) 275-5005
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4188-012 | WI | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| JLB,Inc | Chiropractor | Current | Accepting new patients |
Locations
450 Mill St
#102
Fontana, WI 53125
Phone (262) 275-5005
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": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669531885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 MILL ST",
"address_2": "SUITE 102",
"city": "FONTANA",
"state": "WI",
"postal_code": "531251242",
"telephone_number": "262-275-5005",
"fax_number": "262-275-5004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 MILL ST",
"address_2": "SUITE 102",
"city": "FONTANA",
"state": "WI",
"postal_code": "531251242",
"telephone_number": "262-275-5005",
"fax_number": "262-275-5004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRIA",
"first_name": "JEREMY",
"middle_name": "L",
"name_prefix": "Mr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WI",
"license": "4188-012",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38966200",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fontana, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.