Organization Active NPI

Evolve Chiropractic Woodstock PLLC

  • Chiropractor
  • Woodstock, IL
National Provider Identifier
1063908218
Registry record updated May 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-012415 Issued in IL
Legal business name
EVOLVE CHIROPRACTIC WOODSTOCK PLLC
Practice address
2440 Lake Shore Drive
Woodstock, IL 60098-2980
Phone
(815) 338-9150
NPI assigned
Jul 10, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2024

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

Authorized official

Name
Dr. Ryan Felde
Title
Billing Manager
Phone
(847) 345-7676

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 038-012415 IL Primary

Addresses

Primary practice location

2440 Lake Shore Drive
Woodstock, IL 60098-2980

Mailing address

10705 Ruth Rd
Huntley, IL 60142-7156
Phone (815) 338-9150

Other identifiers 1

IdentifierTypeStateIssuer
1730526104OtherINDIVIDUAL NPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180926000693 IL Part B Supplier - Clinic/Group Practice 4183975477 Receives reassigned benefits from 7 practitioners
Practice locations: Woodstock, IL

National Provider Directory

National Provider Directory

Locations

2440 Lake Shore Dr
Woodstock, IL 60098
Phone (815) 338-9150

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1531180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716940800000",
    "number": "1063908218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10705 RUTH RD",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "601427156",
            "telephone_number": "815-338-9150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2440 LAKE SHORE DRIVE",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600982980",
            "telephone_number": "815-338-9150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE CHIROPRACTIC WOODSTOCK PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-10",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A",
        "authorized_official_last_name": "FELDE",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "847-345-7676",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-012415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1730526104",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; 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.