Individual provider Active NPI

Kirsten F Reay, D.C.

  • Chiropractor
  • Wonder Lake, IL
National Provider Identifier
1205921558
Registry record updated Aug 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038008180 Issued in IL
Practice address
5323 E Wonder Lake Rd
Wonder Lake, IL 60097-9051
Phone
(815) 653-0077
NPI assigned
Oct 3, 2006
Last updated
Aug 18, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 18, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038008180 IL Primary

Addresses

Primary practice location

5323 E Wonder Lake Rd
Wonder Lake, IL 60097-9051

Mailing address

5463 Bull Valley Rd
McHenry, IL 60050-7410
Phone (815) 653-0077

Other identifiers 1

IdentifierTypeStateIssuer
05622784OtherILBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101217000162 IL Practitioner - Chiropractic 9436347457 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5463 Bull Valley Rd
McHenry, IL 60050-7410
Phone (815) 322-2122

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038008180ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Hands That Heal Chiropractic LLC Chiropractor CurrentSince Mar 6, 2013 Accepting new patients
Dennis R Zidek DC Chiropractor Past Accepting new patients
Wonder Lake Chiropractic, LLC Past Accepting new patients

Locations

5463 Bull Valley Rd
McHenry, IL 60050
Phone (630) 208-7703

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566086400000",
    "number": "1205921558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5463 BULL VALLEY RD",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600507410",
            "telephone_number": "815-653-0077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5323 E WONDER LAKE RD",
            "city": "WONDER LAKE",
            "state": "IL",
            "postal_code": "600979051",
            "telephone_number": "815-653-0077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REAY",
        "first_name": "KIRSTEN",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2019-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038008180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "05622784",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wonder Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2019; 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.