Michael Jared Edenzon, DC

Primary specialty

Nutrition ChiropractorTaxonomy code 111NN1001X

License

111NN1001X Issued in DE

Practice address

1010 Concord Avenue
Ste 101
Wilmington, DE 19802-3366

Phone

(302) 777-5551

Fax

(302) 777-5567

NPI assigned

Oct 25, 2006

Last updated

Jun 14, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ, DE2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cillo Chiropractic LLC

  • Chiropractor
  • Blackwood, NJ
  • NPI 1427590827
  Medicare reassignment NPD

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1790860476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 BURNT MILL ROAD",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080033947",
            "telephone_number": "856-422-9234",
            "fax_number": "856-422-9233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 CONCORD AVENUE",
            "address_2": "STE 101",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198023366",
            "telephone_number": "302-777-5551",
            "fax_number": "302-777-5567"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1326 South Governors Avenue",
            "address_2": "Ste D",
            "address_purpose": "LOCATION",
            "city": "Dover",
            "state": "DE",
            "postal_code": "199044800",
            "country_code": "US",
            "telephone_number": "302-264-9770",
            "fax_number": "302-883-2786",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "757 Pulaski Highway",
            "address_2": "Ste 5",
            "address_purpose": "LOCATION",
            "city": "Bear",
            "state": "DE",
            "postal_code": "197015214",
            "country_code": "US",
            "telephone_number": "302-554-5421",
            "fax_number": "302-544-5019",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1101 Twin C Lane",
            "address_2": "Ste 201",
            "address_purpose": "LOCATION",
            "city": "Newark",
            "state": "DE",
            "postal_code": "197132159",
            "country_code": "US",
            "telephone_number": "302-777-5551",
            "fax_number": "302-777-5567",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDENZON",
        "first_name": "MICHAEL",
        "middle_name": "JARED",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "PA",
            "license": "DC-007149-L",
            "primary": false
        },
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "DE",
            "license": "111NN1001X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nutrition Chiropractor in Wilmington, DE
• Providers in Wilmington, DE by specialty
• Nutrition Chiropractor in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.