Jason Michael Fredericks, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3651 Issued in MN

Practice address

8200 Humboldt Ave S Ste 204
Bloomington, MN 55431-1432

Phone

(952) 884-6144

Fax

(952) 884-9180

NPI assigned

May 16, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Institute for Chiropractic Rehabilitation PA

  • Chiropractor
  • Bloomington, MN
  • NPI 1922242627
  Medicare reassignment NPD Authorized official
• Mystical Rose Chiropractic LLC

  • Health Maintenance Organization
  • Bloomington, MN
  • NPI 1649555715
  NPD (past)

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488758400000",
    "number": "1669689295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8200 HUMBOLDT AVE S",
            "address_2": "STE 204",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554311432",
            "telephone_number": "612-386-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8200 HUMBOLDT AVE S STE 204",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554311432",
            "telephone_number": "952-884-6144",
            "fax_number": "952-884-9180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKS",
        "first_name": "JASON",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-16",
        "last_updated": "2017-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5328276-00",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ella Rae Francis, PA-C
• Vanessa Blanche Francis
• Frank Russomanno, Jr, DDS, P.a.
• Travis Lawrence Frantz, M.D.
• Jared A Frazin, MD
• Brittany Morgan Fredrickson, MD
• Freedom Health Care, Inc.
• Daniel Freeman
• Freitag Family Chiropractic LLC
• Jenna French, BCBA

• Chiropractor in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2017; 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.