NPIMap

Organization Active NPI

Tri State Precision Clinic of Chiropractic Inc

Doing business as Tri-state Clinic of Chiropractic

  • Chiropractor
  • Mount Carmel, IL
National Provider Identifier
1154886307
Registry record updated Mar 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
TRI STATE PRECISION CLINIC OF CHIROPRACTIC INC
Doing business as
Tri-state Clinic of Chiropractic
Practice address
229 W 2ND St
Mount Carmel, IL 62863-1608
Phone
(618) 262-2222
Fax
(618) 262-2224
NPI assigned
Feb 1, 2019
Last updated
Mar 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2019

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

Authorized official

Name
Aileen Anne Delacruz, D.C.NPI 1265906770
Title
Sole Owner
Phone
(812) 629-8627

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 Primary

Addresses

Primary practice location

229 W 2ND St
Mount Carmel, IL 62863-1608

Mailing address

229 W 2ND St
Mount Carmel, IL 62863-1608
Phone (812) 629-8624

Other names 1

  • Tri-state Clinic of Chiropractic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190322001293 IL Part B Supplier - Clinic/Group Practice 7618217969 Receives reassigned benefits from 2 practitioners
Practice locations: Mount Carmel, IL

National Provider Directory

National Provider Directory

Locations

229 W 2nd St
Mount Carmel, IL 62863
Phone (618) 262-2222

Practitioners & affiliated clinicians

Practitioners 3

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": "1548979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552867200000",
    "number": "1154886307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 W 2ND ST",
            "city": "MOUNT CARMEL",
            "state": "IL",
            "postal_code": "628631608",
            "telephone_number": "812-629-8624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "229 W 2ND ST",
            "city": "MOUNT CARMEL",
            "state": "IL",
            "postal_code": "628631608",
            "telephone_number": "618-262-2222",
            "fax_number": "618-262-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI STATE PRECISION CLINIC OF CHIROPRACTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-01",
        "last_updated": "2019-03-18",
        "status": "A",
        "authorized_official_last_name": "DELACRUZ",
        "authorized_official_first_name": "AILEEN",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "812-629-8627",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tri-state Clinic of Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tri-state Clinic of Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Carmel, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2019; 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.