Elm Street Medical Center LTD

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038-005010 Issued in IL

Legal business name

ELM STREET MEDICAL CENTER LTD

Practice address

4921 W Elm St
Suite a
McHenry, IL 60050-4020

Phone

(815) 344-1025

Fax

(815) 344-1208

NPI assigned

Apr 10, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth T. Reiser, D.C.

Title

Owner

Phone

(815) 344-1025

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377043200000",
    "number": "1164645008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4921 W ELM ST",
            "address_2": "SUITE A",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600504020",
            "telephone_number": "815-344-1025",
            "fax_number": "815-344-1208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4921 W ELM ST",
            "address_2": "SUITE A",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600504020",
            "telephone_number": "815-344-1025",
            "fax_number": "815-344-1208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELM STREET MEDICAL CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2013-08-21",
        "status": "A",
        "authorized_official_last_name": "REISER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-344-1025",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-005010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038005010",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "05632034",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carmen Elliott
• Vanessa Carola Elliott
• Danielle Ellis
• Linda Lee Ellis
• Kermalene Marie Ellsworth, PTA
• Mohamed S Elmarasi, M.D.
• Samantha Emory
• Patricia L Engelhardt, L.AC.
• Larry Anthony English
• Hillary Enslow

• Chiropractor in McHenry, IL
• Providers in McHenry, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2013; 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.