NPIMap

Organization Active NPI

Bannockburn Chiropractic & Sports Injury Center PC

  • Chiropractor
  • Bannockburn, IL
National Provider Identifier
1134420011
Registry record updated Apr 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
BANNOCKBURN CHIROPRACTIC & SPORTS INJURY CENTER PC
Practice address
2101 Waukegan Rd
100
Bannockburn, IL 60015-1836
Phone
(847) 236-1194
Fax
(847) 236-1195
NPI assigned
Nov 9, 2010
Last updated
Apr 18, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2018

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

Authorized official

Name
Mr. Stuart Evan Yoss, DCNPI 1528133790
Title
President/Owner
Phone
(847) 236-1194

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038.007835 IL
Chiropractor 111N00000X NU Primary
Physical Therapist 225100000X NU

Addresses

Primary practice location

2101 Waukegan Rd
100
Bannockburn, IL 60015-1836

Mailing address

2101 Waukegan Rd
100
Bannockburn, IL 60015-1836
Phone (847) 236-1194

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110531000337 IL Part B Supplier - Clinic/Group Practice 0345427357 Receives reassigned benefits from 6 practitioners
Practice locations: Bannockburn, IL

National Provider Directory

National Provider Directory

Locations

2101 Waukegan Rd
Ste 100
Bannockburn, IL 60015
Phone (847) 236-1194

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1289260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524009600000",
    "number": "1134420011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 WAUKEGAN RD",
            "address_2": "100",
            "city": "BANNOCKBURN",
            "state": "IL",
            "postal_code": "600151836",
            "telephone_number": "847-236-1194",
            "fax_number": "847-236-1195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 WAUKEGAN RD",
            "address_2": "100",
            "city": "BANNOCKBURN",
            "state": "IL",
            "postal_code": "600151836",
            "telephone_number": "847-236-1194",
            "fax_number": "847-236-1195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNOCKBURN CHIROPRACTIC & SPORTS INJURY CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-09",
        "last_updated": "2018-04-18",
        "status": "A",
        "authorized_official_last_name": "YOSS",
        "authorized_official_first_name": "STUART",
        "authorized_official_middle_name": "EVAN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "847-236-1194",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.007835",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bannockburn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2018; 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.