NPIMap

Organization Active NPI

Wellspring Chiropractic & Rehabilitation, LTD.

  • Chiropractor
  • Palos Park, IL
National Provider Identifier
1205986924
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
WELLSPRING CHIROPRACTIC & REHABILITATION, LTD.
Practice address
11901 S 80TH Ave
Suite 1
Palos Park, IL 60464-3102
Phone
(708) 923-9400
Fax
(708) 923-9402
NPI assigned
Jan 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Greganthony A. Cleofe, D.C.NPI 1003926379
Title
Clinic Director
Phone
(708) 923-9400

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X IL Primary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X IL

Addresses

Primary practice location

11901 S 80TH Ave
Suite 1
Palos Park, IL 60464-3102

Mailing address

11901 S 80TH Ave
Suite 1
Palos Park, IL 60464-3102
Phone (708) 923-9400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060223000215 IL Part B Supplier - Clinic/Group Practice 0749296010 Receives reassigned benefits from 1 practitioner
Practice locations: Palos Park, IL

National Provider Directory

National Provider Directory

Locations

11901 S 80th Ave
Ste 1
Palos Park, IL 60464
Phone (708) 923-9400

Practitioners & affiliated clinicians

Practitioners 3

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": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205986924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11901 S 80TH AVE",
            "address_2": "SUITE 1",
            "city": "PALOS PARK",
            "state": "IL",
            "postal_code": "604643102",
            "telephone_number": "708-923-9400",
            "fax_number": "708-923-9402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11901 S 80TH AVE",
            "address_2": "SUITE 1",
            "city": "PALOS PARK",
            "state": "IL",
            "postal_code": "604643102",
            "telephone_number": "708-923-9400",
            "fax_number": "708-923-9402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPRING CHIROPRACTIC & REHABILITATION, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLEOFE",
        "authorized_official_first_name": "GREGANTHONY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "708-923-9400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palos Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.