Individual provider Active NPI

Robert Joseph Brown, D.C.

  • Chiropractor
  • Staunton, IL
National Provider Identifier
1205940947
Registry record updated Oct 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-003458 Issued in IL
Practice address
704 S Hackman St
Staunton, IL 62088-1630
Phone
(618) 635-2502
NPI assigned
Aug 19, 2006
Last updated
Oct 24, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038-003458 IL Primary

Addresses

Primary practice location

704 S Hackman St
Staunton, IL 62088-1630

Mailing address

704 S Hackman St
Staunton, IL 62088-1630
Phone (618) 635-2502

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051010000403 IL Practitioner - Chiropractic 8325063357 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038-003458ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Macoupin County Chiro Partnership Chiropractor CurrentSince May 13, 2011 Accepting new patients
North Arkansas Regional Medical Center PastSince May 13, 2011 Accepting new patients
Staunton Chiropractic Clinic, Inc. Chiropractor PastSince Oct 1, 2004 Accepting new patients

Locations

490 W Side Sq
Carlinville, IL 62626
Phone (217) 854-2557

704 S Hackman St
Staunton, IL 62088
Phone (618) 635-2502

Interoperability endpoints

  • Direct secure messaging: mc@mcc0017.direct.chirotouch.md

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": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351036800000",
    "number": "1205940947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 S HACKMAN ST",
            "city": "STAUNTON",
            "state": "IL",
            "postal_code": "620881630",
            "telephone_number": "618-635-2502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 S HACKMAN ST",
            "city": "STAUNTON",
            "state": "IL",
            "postal_code": "620881630",
            "telephone_number": "618-635-2502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "ROBERT",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2012-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-003458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staunton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2012; 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.