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Organization Active NPI

Active Rehab Chiropractic LLC

  • Chiropractor
  • Glen Carbon, IL
National Provider Identifier
1073291811
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
ACTIVE REHAB CHIROPRACTIC LLC
Practice address
4225 S State Route 159 Ste 2
Glen Carbon, IL 62034-3231
Phone
(618) 641-3111
NPI assigned
Jul 11, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

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

Authorized official

Name
Marshall Gevers, DC
Title
Owner
Phone
(618) 520-8270

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

4225 S State Route 159 Ste 2
Glen Carbon, IL 62034-3231

Mailing address

4225 S State Route 159 Ste 2
Glen Carbon, IL 62034-3231
Phone (618) 641-3111

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1689033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689033600000",
    "number": "1073291811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 S STATE ROUTE 159 STE 2",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343231",
            "telephone_number": "618-641-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 S STATE ROUTE 159 STE 2",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343231",
            "telephone_number": "618-641-3111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE REHAB CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-11",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A",
        "authorized_official_last_name": "GEVERS",
        "authorized_official_first_name": "MARSHALL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-520-8270",
        "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": []
}

Other providers in Glen Carbon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.