Individual provider Active NPI

Robert J Dieringer, DC

  • Chiropractor
  • Mokena, IL
National Provider Identifier
1174603294
Registry record updated Jul 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038009120 Issued in IL
Practice address
19806 Wolf Rd Unit 4
Mokena, IL 60448-1385
Phone
(708) 478-0620
NPI assigned
Oct 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038009120 IL Primary

Addresses

Primary practice location

19806 Wolf Rd Unit 4
Mokena, IL 60448-1385

Mailing address

11141 W 191St St
Mokena, IL 60448-9278
Phone (708) 478-0620

Other identifiers 1

IdentifierTypeStateIssuer
9927031OtherILBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040312000905 IL Practitioner - Chiropractic 2466341995 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

19806 Wolf Rd
Apt 104
Mokena, IL 60448-1386
Phone (708) 478-0620

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038009120ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Dieringer Chiropractic Health Clinic, LTD. Chiropractor CurrentSince Jul 29, 2013 Accepting new patients
Wheelchair Sales & Service, Inc. PastSince Jan 17, 2022 Accepting new patients

Locations

11141 191st St
Mokena, IL 60448
Phone (708) 478-0620

19806 Wolf Rd
Apt 104
Mokena, IL 60448
Phone (708) 478-0620

Organizations & group practices 2

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": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689206400000",
    "number": "1174603294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11141 W 191ST ST",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604489278",
            "telephone_number": "708-478-0620",
            "fax_number": "708-479-8948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19806 WOLF RD UNIT 4",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604481385",
            "telephone_number": "708-478-0620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIERINGER",
        "first_name": "ROBERT",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2023-07-13",
        "certification_date": "2023-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038009120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "9927031",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mokena, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2023; 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.