Organization Active NPI

Schelly Chiropractic, Inc

  • Chiropractor
  • Peoria, IL
National Provider Identifier
1194027003
Registry record updated Mar 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
38006410 Issued in IL
Legal business name
SCHELLY CHIROPRACTIC, INC
Practice address
1208 W Loucks
Peoria, IL 61604
Phone
(309) 682-6624
Fax
(309) 682-6625
NPI assigned
Nov 29, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2011

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

Authorized official

Name
Dr. Laura J Schelly, DCNPI 1689739492
Title
Owner/Doctor
Phone
(309) 682-6624

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 38006410 IL Primary

Addresses

Primary practice location

1208 W Loucks
Peoria, IL 61604

Mailing address

1208 W Loucks Ave
Peoria, IL 61604-2604
Phone (309) 682-6624

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110314000975 IL Part B Supplier - Clinic/Group Practice 3971785858 Receives reassigned benefits from 1 practitioner
Practice locations: Peoria, IL

National Provider Directory

National Provider Directory

Locations

4238 N Knoxville Ave
Peoria, IL 61614
Phone (309) 282-6419

1208 W Loucks Ave
Peoria, IL 61604
Phone (309) 682-6624

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1290988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300924800000",
    "number": "1194027003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 W LOUCKS AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616042604",
            "telephone_number": "309-682-6624",
            "fax_number": "309-682-6625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208 W LOUCKS",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61604",
            "telephone_number": "309-682-6624",
            "fax_number": "309-682-6625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCHELLY CHIROPRACTIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-29",
        "last_updated": "2011-03-24",
        "status": "A",
        "authorized_official_last_name": "SCHELLY",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "309-682-6624",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "38006410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2011; 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.