NPIMap

Organization Active NPI

Bruketa Family Chiropractic

  • Chiropractor
  • Peoria, IL
National Provider Identifier
1104283357
Registry record updated Jan 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038.012927 Issued in IL
Legal business name
BRUKETA FAMILY CHIROPRACTIC
Practice address
7310 N Villa Lake Dr
Peoria, IL 61614-8267
Phone
(309) 691-9767
NPI assigned
Jan 19, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2016

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

Authorized official

Name
Kyle Bruketa, D.C.NPI 1205293446
Title
Owner
Phone
(309) 258-5738

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 038.012927 IL Primary

Addresses

Primary practice location

7310 N Villa Lake Dr
Peoria, IL 61614-8267

Mailing address

7310 N Villa Lake Dr
Peoria, IL 61614-8267

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1453161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453161600000",
    "number": "1104283357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7310 N VILLA LAKE DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7310 N VILLA LAKE DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616148267",
            "telephone_number": "309-691-9767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUKETA FAMILY CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-19",
        "last_updated": "2016-01-19",
        "status": "A",
        "authorized_official_last_name": "BRUKETA",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-258-5738",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.012927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2016; 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.