Jennifer Fanchon Vondrak, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

AO6224 Issued in IA

Practice address

102 Boyer St.
Suite B
Wall Lake, IA 51466

Phone

(712) 664-2054

Fax

(712) 664-2053

NPI assigned

Mar 14, 2006

Last updated

Jan 9, 2018By the provider in NPPES

Sex

Female

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 IA

Enrollment records 1

Specialty

Chiropractic

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Twilight Acres Inc.

  • Skilled Nursing Facility
  • Wall Lake, IA
  • NPI 1265425490
  NPD (past)

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515456000000",
    "number": "1689643736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 BOYER ST.",
            "address_2": "SUITE B",
            "city": "WALL LAKE",
            "state": "IA",
            "postal_code": "51466",
            "telephone_number": "712-664-2054",
            "fax_number": "712-664-2053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 BOYER ST.",
            "address_2": "SUITE B",
            "city": "WALL LAKE",
            "state": "IA",
            "postal_code": "51466",
            "telephone_number": "712-664-2054",
            "fax_number": "712-664-2053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VONDRAK",
        "first_name": "JENNIFER",
        "middle_name": "FANCHON",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2018-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "AO6224",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1198671",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Arlene Drost, DPT
• Mary's Care Memorial Clinic
• Brooke Nordquist, DDS
• St Anthony Wall Lake Pharmacy (St Anthony Wall Lake Phcy)
• Twilight Acres Inc.

• Chiropractor in Wall Lake, IA
• Providers in Wall Lake, IA by specialty
• Chiropractor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.