JESSICA ROSE DREDSKE DC
Complete NPI Record 1194237123
Chiropractor in Portage, WI
NPI Status: Active since October 31, 2017
Complete NPI Dataset
The following table represents the complete dataset for NPI number 1194237123. The table includes a list of all field names, values and definitions of the full NPI record. This dataset is available for download in CSV format using the "Download NPI" button below at the end of the table.
| Name | Value | Definition |
|---|---|---|
| NPI | 1194237123 | The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
| Entity Type Code | 1 | Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
| Provider Last Name Legal Name | DREDSKE | The last name of the provider. If the provider is an individual, this is the legal name. |
| Provider First Name | JESSICA | The first name of the provider, if the provider is an individual. |
| Provider Middle Name | ROSE | The middle name of the provider, if the provider is an individual. |
| Provider Credential Text | DC | The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS. |
| Provider First Line Business Mailing Address | 641 LATTON LN | The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’. |
| Provider Business Mailing Address City Name | PORTAGE | The city name in the mailing address of the provider being identified. |
| Provider Business Mailing Address State Name | WI | The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’. |
| Provider Business Mailing Address Postal Code | 539011078 | The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’. |
| Provider Business Mailing Address Country Code If outside U S | US | The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’. |
| Provider Business Mailing Address Telephone Number | 6087421300 | The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’. |
| Provider First Line Business Practice Location Address | 641 LATTON LN | The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
| Provider Business Practice Location Address City Name | PORTAGE | The city name in the location address of the provider being identified. |
| Provider Business Practice Location Address State Name | WI | The State code in the location of the provider being identified. |
| Provider Business Practice Location Address Postal Code | 539011078 | The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Business Practice Location Address Country Code If outside U S | US | The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address Telephone Number | 6087421300 | The telephone number associated with the location address of the provider being identified. |
| Provider Enumeration Date | 10/31/2017 | The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date | 10/31/2017 | The date that a record was last updated or changed. |
| Provider Gender Code | F | The code designating the provider’s gender if the provider is a person. |
| Healthcare Provider Taxonomy Code 1 | 111N00000X | Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Provider License Number 1 | 5308-12 | The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider License Number State Code 1 | WI | The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Healthcare Provider Primary Taxonomy Switch 1 | Y | |
| Is Sole Proprietor | N | Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |