Organization Active NPI

Evolve Chiropractic Crystal Lake PLLC

  • Chiropractor
  • Crystal Lake, IL
National Provider Identifier
1194575811
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
EVOLVE CHIROPRACTIC CRYSTAL LAKE PLLC
Practice address
6320 Northwest Hwy
Crystal Lake, IL 60014-7935
Phone
(224) 250-3526
NPI assigned
Mar 25, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

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

Authorized official

Name
Scott Cruse, CDNPI 1003103938
Title
Owner
Phone
(224) 250-3526

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: 193200000X MULTI-SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

6320 Northwest Hwy
Crystal Lake, IL 60014-7935

Mailing address

10705 Ruth Rd
Huntley, IL 60142-7156

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240725000884 IL Part B Supplier - Clinic/Group Practice 9436695525 Receives reassigned benefits from 4 practitioners
Practice locations: Crystal Lake, IL

National Provider Directory

National Provider Directory

Locations

6320 Northwest Hwy
Crystal Lake, IL 60014
Phone (224) 250-3526

Practitioners & affiliated clinicians

Practitioners 5

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": "1711324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724716800000",
    "number": "1194575811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10705 RUTH RD",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "601427156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6320 NORTHWEST HWY",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147935",
            "telephone_number": "224-250-3526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE CHIROPRACTIC CRYSTAL LAKE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-25",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A",
        "authorized_official_last_name": "CRUSE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "224-250-3526",
        "authorized_official_credential": "CD"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; 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.