Fredericks Chiropractic Center, LTD.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038005902 Issued in IL

Legal business name

FREDERICKS CHIROPRACTIC CENTER, LTD.

Practice address

166 N Gary Ave
Carol Stream, IL 60188-2093

Phone

(630) 665-5656

NPI assigned

Jun 18, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Kevin A Fredericks, DCNPI 1104906213

Title

President

Phone

(630) 665-5656

Specialties & licenses 1

Addresses

Other identifiers 3

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.

• Kevin A Fredericks, D.C.

  • Chiropractor
  • Carol Stream, IL
  • NPI 1104906213
  Medicare reassignment NPD Authorized official
• George Eugene Radice, DC

  • Chiropractor
  • Carol Stream, IL
  • NPI 1407914534
  NPD (past)

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

{
    "created_epoch": "1213747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1063673572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 N GARY AVE",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882093",
            "telephone_number": "630-665-5656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 N GARY AVE",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882093",
            "telephone_number": "630-665-5656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICKS CHIROPRACTIC CENTER, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-18",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "FREDERICKS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-665-5656",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038005902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "764930",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "T38747",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF ILLINOIS",
            "identifier": "2215441",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gail M Feltault, OTD, OTR/L
• Jason Cleo Fowler, D.C.
• Francis S Lichon MD SC
• Patricia Rose Francis, PSY.D.
• Adriana Patricia Franco, LCSW, CRADC
• Kevin A Fredericks, D.C.
• David A Fruhauf, D.C.
• Jordyn Fulton, OTD, OTR/L
• Parth Gabhawala, PT
• Katarzyna Gacek, FNP-BC

• All providers in Carol Stream, IL
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; 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.