Active NPI
Bryan Huitzacua
- Chiropractor
- Harvard, IL
National Provider Identifier
1114077609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- Practice address
- 30 N Ayer St
Harvard, IL 60033-2861 - Phone
- (815) 943-9150
- Fax
- (815) 943-6122
- NPI assigned
- Jan 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | IL | Primary |
Addresses
Primary practice location
30 N Ayer St
Harvard, IL 60033-2861
Mailing address
30 N Ayer St
Harvard, IL 60033-2861
Phone (815) 943-9150
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081114000044 | IL | Practitioner - Chiropractic | 0648330100 | Practice locations: Harvard, IL |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - West Sunnyvale, 1985
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
30 N Ayer St
Harvard, IL 60033-2861
Phone (815) 943-9150
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038005527 | IL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114077609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 N AYER ST",
"city": "HARVARD",
"state": "IL",
"postal_code": "600332861",
"telephone_number": "815-943-9150",
"fax_number": "815-943-6122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 N AYER ST",
"city": "HARVARD",
"state": "IL",
"postal_code": "600332861",
"telephone_number": "815-943-9150",
"fax_number": "815-943-6122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUITZACUA",
"first_name": "BRYAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Harvard, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.