NPIMap

Organization Active NPI

Haven Chiropractic Care, PC

  • Clinic/Center
  • O'Fallon, IL
National Provider Identifier
1205600863
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
HAVEN CHIROPRACTIC CARE, PC
Practice address
102 Willow Dr Ste a
O Fallon, IL 62269-1073
Phone
(618) 799-0690
NPI assigned
Nov 14, 2023
Last updated
Nov 14, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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

Authorized official

Name
Dr. Randi Tyler, DCNPI 1740534320
Title
President
Phone
(618) 799-0690

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
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

102 Willow Dr Ste a
O Fallon, IL 62269-1073

Mailing address

102 Willow Dr Ste a
O Fallon, IL 62269-1073
Phone (618) 799-0690

National Provider Directory

National Provider Directory

Locations

102 Willow Dr
Ste A
O Fallon, IL 62269
Phone (618) 799-0690

Practitioners & affiliated clinicians

Practitioners 1

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": "1699920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699920000000",
    "number": "1205600863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 WILLOW DR STE A",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691073",
            "telephone_number": "618-799-0690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 WILLOW DR STE A",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691073",
            "telephone_number": "618-799-0690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN CHIROPRACTIC CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-14",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A",
        "authorized_official_last_name": "TYLER",
        "authorized_official_first_name": "RANDI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-799-0690",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; 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.