Pro Active Chiropractic PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

PRO ACTIVE CHIROPRACTIC PC

Practice address

223 W Jackson Blvd Ste 1016
Chicago, IL 60606-6916

Phone

(708) 351-2011

NPI assigned

Oct 19, 2018

Organization subpart

No

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

Authorized official

Name

Dana Garlan Riederer, DCNPI 1104003649

Title

President

Phone

(708) 351-2011

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

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

• Dana Garlan Riederer, DC

  • Chiropractor
  • Chicago, IL
  • NPI 1104003649
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1539907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581552000000",
    "number": "1013483874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S CATHERINE AVE",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605252829",
            "telephone_number": "708-351-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 W JACKSON BLVD STE 1016",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606066916",
            "telephone_number": "708-351-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO ACTIVE CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-19",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A",
        "authorized_official_last_name": "RIEDERER",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "GARLAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-351-2011",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Chicago, IL
• Providers in Chicago, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; 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.