Individual provider Active NPI

Anthony Petrarca, DC

  • Chiropractor
  • Carol Stream, IL
National Provider Identifier
1164062626
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038.013496 Issued in IL
Practice address
270 W Army Trail Rd
Carol Stream, IL 60188-9368
Phone
(630) 517-5674
Fax
(630) 300-3702
NPI assigned
Jan 13, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038.013496 IL Primary

Addresses

Primary practice location

270 W Army Trail Rd
Carol Stream, IL 60188-9368

Mailing address

270 W Amry Trail Rd
Carol Stream, IL 60188-9368
Phone (630) 517-5674

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200204001569 IL Practitioner - Chiropractic 6901232354 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bodyworks Medical Center PLLCGroup PAC ID 6507110905, 4 clinicians

Practice addresses (Care Compare)

270 W Army Trail Rd
Carol Stream, IL 60188-9368
Phone (630) 517-5674

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038.013496ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Bodyworks Medical Center PLLC CurrentSince Aug 29, 2024 Accepting new patients
Multicare Health Center LTD Chiropractor CurrentSince Jan 7, 2020 Accepting new patients
The Rehab Centre, Inc. PastSince May 24, 2016 Accepting new patients
Pain Med P C Past Accepting new patients

Locations

270 W Army Trail Rd
Carol Stream, IL 60188
Phone (630) 517-5674

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1578873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1164062626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 W AMRY TRAIL RD",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601889368",
            "telephone_number": "630-517-5674",
            "fax_number": "630-300-3702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 W ARMY TRAIL RD",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601889368",
            "telephone_number": "630-517-5674",
            "fax_number": "630-300-3702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRARCA",
        "first_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-13",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.013496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carol Stream, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; 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.

Verify at the official NPI Registry.