Southern Illinois Spine & Joint Center of Marissa LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038011854 Issued in IL

Legal business name

SOUTHERN ILLINOIS SPINE & JOINT CENTER OF MARISSA LLC

Practice address

112 N Main St
Marissa, IL 62257-1365

Phone

(618) 295-2268

Fax

(618) 295-3521

NPI assigned

Oct 22, 2012

Last updated

Dec 12, 2012By 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. Ryan Reiss, D.C.NPI 1144324377

Title

Manager

Phone

(618) 443-2026

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

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.

• Dillon Lee Kaesberg, D.C.

  • Chiropractor
  • Marissa, IL
  • NPI 1821392952
  Medicare reassignment NPD
• Ryan Robert Reiss, DC

  • Chiropractor
  • Sparta, IL
  • NPI 1144324377
  Authorized official Same address or phone

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

{
    "created_epoch": "1350864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355270400000",
    "number": "1053664557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 N MAIN ST",
            "city": "MARISSA",
            "state": "IL",
            "postal_code": "622571365",
            "telephone_number": "618-295-2268",
            "fax_number": "618-295-3521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 N MAIN ST",
            "city": "MARISSA",
            "state": "IL",
            "postal_code": "622571365",
            "telephone_number": "618-295-2268",
            "fax_number": "618-295-3521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS SPINE & JOINT CENTER OF MARISSA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-22",
        "last_updated": "2012-12-12",
        "status": "A",
        "authorized_official_last_name": "REISS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "618-443-2026",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038011854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Ramicone
• Megan Schmersahl
• Brittany M Segelhorst
• Southern Illinois Eye Care, PC (Marissa Eyecare)
• Southern Illinois Spine & Joint Center
• Sparta Community Hospital D/B/a Quality Healthcare Clinics

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2012; 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.