Healthsource Chiropractic of Champaign, S.C.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

038.012800 Issued in IL

Legal business name

HEALTHSOURCE CHIROPRACTIC OF CHAMPAIGN, S.C.

Practice address

2003 Round Barn Rd
Suite B
Champaign, IL 61821-6827

Phone

(217) 281-0006

NPI assigned

Feb 9, 2017

Last updated

Jan 16, 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

Dr. Cameron Robert Mackichan, D.C.NPI 1487008272

Title

Owner

Phone

(217) 281-0006

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, and the practitioner matching its NPPES authorized official.

• Cameron Robert Mackichan, D.C.

  • Chiropractor
  • Champaign, IL
  • NPI 1487008272
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1486598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516060800000",
    "number": "1023556164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 ROUND BARN RD",
            "address_2": "SUITE B",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618216827",
            "telephone_number": "217-281-0006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 ROUND BARN RD",
            "address_2": "SUITE B",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618216827",
            "telephone_number": "217-281-0006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE CHIROPRACTIC OF CHAMPAIGN, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-09",
        "last_updated": "2018-01-16",
        "status": "A",
        "authorized_official_last_name": "MACKICHAN",
        "authorized_official_first_name": "CAMERON",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-281-0006",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "038.012800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ryan Douglas Heath, MA, PH.D.

• Clinic/Center in Champaign, IL
• Providers in Champaign, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2018; 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.