Stateline Chiropractic & Sports Injury Clinic SC

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

038008186 Issued in IL

Legal business name

STATELINE CHIROPRACTIC & SPORTS INJURY CLINIC SC

Practice address

1407 Pate Plaza Dr
South Beloit, IL 61080

Phone

(815) 389-7870

NPI assigned

May 3, 2007

Last updated

Aug 1, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joseph Probst, DCNPI 1265558837

Title

President

Phone

(815) 389-7870

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joseph C Probst, DC

  • Sports Physician Chiropractor
  • South Beloit, IL
  • NPI 1265558837
  Authorized official Same address or phone

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533081600000",
    "number": "1003028127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 PATE PLAZA DR",
            "city": "SOUTH BELOIT",
            "state": "IL",
            "postal_code": "610801431",
            "telephone_number": "815-389-7870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 PATE PLAZA DR",
            "city": "SOUTH BELOIT",
            "state": "IL",
            "postal_code": "61080",
            "telephone_number": "815-389-7870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATELINE CHIROPRACTIC & SPORTS INJURY CLINIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2018-08-01",
        "status": "A",
        "authorized_official_last_name": "PROBST",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-389-7870",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "IL",
            "license": "038008186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC NUMBER",
            "identifier": "038008186",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Teresa Ann Sambrook, RN
• Nicole M Simpson, N.P.
• Catherine Jean Smith, M.A., CF-SLP
• Michelle Kay Smith, P.T.A.
• South Beloit Office
• Nic Stewart, SSP
• Christine Strange, DO
• The Board of Trustees of the University of Illinois (University Clinic at South Beloit - Junior High)
• Tera Wenner, BCBA
• Helen Wild, IBCLC

• Sports Physician Chiropractor in South Beloit, IL
• Providers in South Beloit, IL by specialty
• Sports Physician Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.