Active NPI
John Richard Jezioro, DC
- Chiropractor
- Fairmont, WV
National Provider Identifier
1871669614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 660
- Practice address
- 1565 Fairmont Ave
Fairmont, WV 26554-2158 - Phone
- (304) 363-8890
- Fax
- (304) 363-8902
- NPI assigned
- Nov 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 660 | WV | Primary |
Addresses
Primary practice location
1565 Fairmont Ave
Fairmont, WV 26554-2158
Mailing address
1565 Fairmont Ave
Fairmont, WV 26554-2158
Phone (304) 363-8890
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000342746 | Other | WV | BCBS |
| 7600047000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101129000278 | WV | Practitioner - Chiropractic | 5092901348 | Practice locations: Fairmont, WV |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1565 Fairmont Ave
Fairmont, WV 26554-2158
Phone (304) 363-8890
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 660 | WV | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322524800000",
"number": "1871669614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1565 FAIRMONT AVE",
"city": "FAIRMONT",
"state": "WV",
"postal_code": "265542158",
"telephone_number": "304-363-8890",
"fax_number": "304-363-8902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1565 FAIRMONT AVE",
"city": "FAIRMONT",
"state": "WV",
"postal_code": "265542158",
"telephone_number": "304-363-8890",
"fax_number": "304-363-8902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEZIORO",
"first_name": "JOHN",
"middle_name": "RICHARD",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-24",
"last_updated": "2011-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WV",
"license": "660",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "000342746",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7600047000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairmont, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2011; 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.