Ethan Deweerd, D.C

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH12589 Issued in FL

Practice address

1103 Lithia Pinecrest Rd
Brandon, FL 33511-6713

Phone

(813) 868-1138

Fax

(813) 868-1137

NPI assigned

Apr 22, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valrico Spine and Rehab CenterGroup PAC ID 4880820737, 3 clinicians

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.

• Valrico Spine and Rehab Center

  • Chiropractor
  • Brandon, FL
  • NPI 1215363981
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1619049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619049600000",
    "number": "1679155444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 LITHIA PINECREST RD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335116713",
            "telephone_number": "813-868-1138",
            "fax_number": "813-868-1137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 LITHIA PINECREST RD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335116713",
            "telephone_number": "813-868-1138",
            "fax_number": "813-868-1137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWEERD",
        "first_name": "ETHAN",
        "credential": "D.C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-22",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH12589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "frontoffice@valricochiropractor.com",
            "affiliation": "Y",
            "endpointDescription": "Email",
            "affiliationName": "Valrico Spine and Rehab Center",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1103 Lithia Pinecrest Rd",
            "city": "Brandon",
            "state": "FL",
            "country_code": "US",
            "postal_code": "335116713",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristina Deveau
• Nicole M Devine-Horner, LMT
• Charles Durwood Devine, M.D.
• Shelby Durrance Devinney, PA-C
• Jacquelyn Marie Devito, NP
• Robert M Dewhurst, MD
• Parminder Dhaliwal, MD
• Teresa 'Terry' Diak, LMHC
• Lagena Dial
• Sharon Lisa Diamond, ARNP-C

• Chiropractor in Brandon, FL
• Providers in Brandon, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2021; 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.