NPIMap

Organization Active NPI

St. Charles Service Corporation

Doing business as Olympia Chiropractic and Physical Therapy

  • Chiropractor
  • St Charles, IL
National Provider Identifier
1093070567
Registry record updated Jul 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038007980 Issued in IL
Legal business name
ST. CHARLES SERVICE CORPORATION
Doing business as
Olympia Chiropractic and Physical Therapy
Practice address
1615 W. Main Street
St. Charles, IL 60174
Phone
(630) 830-8600
Fax
(630) 830-2273
NPI assigned
Jul 10, 2012
Last updated
Jul 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2012

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

Authorized official

Name
Pasquale G. Calcagno, DCNPI 1376611525
Title
Doctor of Chiropractic
Phone
(630) 830-8600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 038007980 IL Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X IL

Addresses

Primary practice location

1615 W. Main Street
St. Charles, IL 60174

Mailing address

260 E. Army Trail Rd,
Suite D
Bartlett, IL 60103-3005
Phone (630) 830-8600

Other names 1

  • Olympia Chiropractic and Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121024000812 IL Part B Supplier - Clinic/Group Practice 1456501667 Receives reassigned benefits from 11 practitioners
Practice locations: St Charles, IL

National Provider Directory

National Provider Directory

Locations

260 E Army Trail Rd
Ste D
Bartlett, IL 60103
Phone (630) 830-8600

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341878400000",
    "number": "1093070567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 E. ARMY TRAIL RD,",
            "address_2": "SUITE D",
            "city": "BARTLETT",
            "state": "IL",
            "postal_code": "601033005",
            "telephone_number": "630-830-8600",
            "fax_number": "630-830-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 W. MAIN STREET",
            "city": "ST. CHARLES",
            "state": "IL",
            "postal_code": "60174",
            "telephone_number": "630-830-8600",
            "fax_number": "630-830-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CHARLES SERVICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-10",
        "last_updated": "2012-07-10",
        "status": "A",
        "authorized_official_last_name": "CALCAGNO",
        "authorized_official_first_name": "PASQUALE",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "630-830-8600",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038007980",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olympia Chiropractic and Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Charles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.