Individual provider Active NPI

Jennifer R Kujawski, D.C.

  • Chiropractor
  • Waterloo, IL
National Provider Identifier
1710111703
Registry record updated Aug 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038011414 Issued in IL
Practice address
210 N Market St Ste D
Waterloo, IL 62298-1531
Phone
(618) 939-4110
Fax
(618) 939-4116
NPI assigned
May 6, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038011414 IL Primary

Addresses

Primary practice location

210 N Market St Ste D
Waterloo, IL 62298-1531

Mailing address

343 W 4TH St
Waterloo, IL 62298-1338
Phone (618) 939-5585

Other practice location 1

343 W 4th St
Waterloo, IL 62298-1338
Phone (618) 939-5585

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090605000585 IL Practitioner - Chiropractic 7416007869 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stratton Chiropractic and Family Health Center P.C.Group PAC ID 3870621220, 3 clinicians

Practice addresses (Care Compare)

343 W 4TH St
Waterloo, IL 62298-1338

824 N Market St
Waterloo, IL 62298-1050
Phone (618) 939-5585

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038011414ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Stratton Chiropractic and Family Health Center P.C. CurrentSince Sep 6, 2022 Accepting new patients
Kohlmeier Chiropractic Therapy Chiropractor Past Accepting new patients

Locations

343 W 4th St
Waterloo, IL 62298
Phone (618) 939-5585

824 N Market St
Waterloo, IL 62298
Phone (618) 939-5585

Organizations & group practices 2

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": "1241568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660780800000",
    "number": "1710111703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 W 4TH ST",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981338",
            "telephone_number": "618-939-5585",
            "fax_number": "618-939-2099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 N MARKET ST STE D",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981531",
            "telephone_number": "618-939-4110",
            "fax_number": "618-939-4116"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "343 W 4th St",
            "address_purpose": "LOCATION",
            "city": "Waterloo",
            "state": "IL",
            "postal_code": "622981338",
            "country_code": "US",
            "telephone_number": "618-939-5585",
            "fax_number": "618-939-2099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUJAWSKI",
        "first_name": "JENNIFER",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-06",
        "last_updated": "2022-08-18",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038011414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; 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.