Jeremy A. Gunderson, D.C.
Individual provider Active NPI Chiropractor · Rockton, IL
NPI 1982715488 · NPPES record last updated Jan 28, 2008
Key facts
- NPI
- 1982715488
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- Practice address
- 506 S Blackhawk
Rockton, IL 61072-2908 - Phone
- (815) 624-2669
- Fax
- (815) 624-0488
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 2001
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Gunderson Clinic of Chiropractic Inc.
Practice addresses (Care Compare)
506 S Blackhawk Blvd
Rockton, IL 61072-2908
Phone (815) 624-2669
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111027000232 | IL | Practitioner - Chiropractic | 7113190752 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038 009535 | IL | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | IL | Yes |
Addresses
Primary practice location
506 S Blackhawk
Rockton, IL 61072-2908
Mailing address
506 S Blackhawk
Rockton, IL 61072-2908
Phone (815) 624-2669
Other providers in Rockton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.