Individual provider Active NPI

Jerrald B Dreessen, DC CCSP

  • Chiropractor
  • Mountlake Terrace, WA
National Provider Identifier
1710042510
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH00002267 Issued in WA
Practice address
6603 220TH St SW
Ste 100
Mountlake Terrace, WA 98043
Phone
(425) 670-2600
Fax
(425) 778-7073
NPI assigned
Dec 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH00002267 WA Primary

Addresses

Primary practice location

6603 220TH St SW
Ste 100
Mountlake Terrace, WA 98043

Mailing address

6603 220TH St SW
Ste 100
Mountlake Terrace, WA 98043
Phone (425) 670-2600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080109000783 WA Practitioner - Chiropractic 7113911942 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Western States College of Chiropractic, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6603 220TH St SW
Suite 100
Mountlake Terrace, WA 98043-2186
Phone (425) 670-2600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH00002267WAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Back to Action Chiropractic LLC Chiropractor CurrentSince Oct 17, 2006 Accepting new patients

Locations

6603 220th St SW
Ste 100
Mountlake Terrace, WA 98043
Phone (425) 670-2600

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710042510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6603 220TH ST SW",
            "address_2": "STE 100",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "98043",
            "telephone_number": "425-670-2600",
            "fax_number": "425-778-7073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6603 220TH ST SW",
            "address_2": "STE 100",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "98043",
            "telephone_number": "425-670-2600",
            "fax_number": "425-778-7073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DREESSEN",
        "first_name": "JERRALD",
        "middle_name": "B",
        "credential": "DC CCSP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00002267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountlake Terrace, WA

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.

Verify at the official NPI Registry.