Organization Active NPI

Jacquette Chiropractic SC

  • Chiropractor
  • Brookfield, WI
National Provider Identifier
1861565814
Registry record updated Apr 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
JACQUETTE CHIROPRACTIC SC
Practice address
13740 W Capitol Dr
Brookfield, WI 53005-2407
Phone
(262) 781-3332
Fax
(262) 781-6477
NPI assigned
Nov 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2009

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

Authorized official

Name
Dr. Mark R Jacquette, D.C.NPI 1649380528
Title
President
Phone
(262) 781-3332

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X WI Primary

Addresses

Primary practice location

13740 W Capitol Dr
Brookfield, WI 53005-2407

Mailing address

13740 W Capitol Dr
Brookfield, WI 53005-2407
Phone (262) 781-3332

Other identifiers 1

IdentifierTypeStateIssuer
38999000MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090421000317 WI Part B Supplier - Clinic/Group Practice 8224185715 Receives reassigned benefits from 1 practitioner
Practice locations: Brookfield, WI

National Provider Directory

National Provider Directory

Locations

13740 W Capitol Dr
Brookfield, WI 53005
Phone (262) 781-3332

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240272000000",
    "number": "1861565814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13740 W CAPITOL DR",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530052407",
            "telephone_number": "262-781-3332",
            "fax_number": "262-781-6477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13740 W CAPITOL DR",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530052407",
            "telephone_number": "262-781-3332",
            "fax_number": "262-781-6477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACQUETTE CHIROPRACTIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2009-04-21",
        "status": "A",
        "authorized_official_last_name": "JACQUETTE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-781-3332",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38999000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2009; 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.