NPIMap

Organization Active NPI

Wicker Park Spine and Stability, LLC

  • Chiropractor
  • Chicago, IL
National Provider Identifier
1184370538
Registry record updated Feb 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
WICKER PARK SPINE AND STABILITY, LLC
Practice address
1641-1643 W North Ave
Unit 1
Chicago, IL 60622
Phone
(312) 928-9282
Fax
(312) 588-7211
NPI assigned
Feb 24, 2022
Last updated
Feb 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2022

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

Authorized official

Name
Jodi Heather Kirsch, DCNPI 1407154446
Title
Owner
Phone
(312) 928-9282

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X Primary
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

1641-1643 W North Ave
Unit 1
Chicago, IL 60622

Mailing address

212 N Carpenter St Unit A1A2
Chicago, IL 60607-1713
Phone (312) 928-9282

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address wlss@wlspine.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220727003234 IL Part B Supplier - Clinic/Group Practice 3274915988 Receives reassigned benefits from 4 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

212 N Carpenter St
Unit A1A2
Chicago, IL 60607

Practitioners & affiliated clinicians

Practitioners 7

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": "1645660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1184370538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 N CARPENTER ST UNIT A1A2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606071713",
            "telephone_number": "312-928-9282",
            "fax_number": "312-588-7211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1641-1643 W NORTH AVE",
            "address_2": "UNIT 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60622",
            "telephone_number": "312-928-9282",
            "fax_number": "312-588-7211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICKER PARK SPINE AND STABILITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-24",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-12",
        "status": "A",
        "authorized_official_last_name": "KIRSCH",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "HEATHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-928-9282",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wlss@wlspine.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1641-1643 W North Ave",
            "address_2": "Unit 1",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60622",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; 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.