Eastland Lifestyle Center

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

EASTLAND LIFESTYLE CENTER

Practice address

2710 E Lincoln St
Bloomington, IL 61704-6010

Phone

(309) 662-8418

Fax

(309) 662-8197

NPI assigned

Oct 3, 2016

Last updated

Aug 27, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jessica Bruin, D.C.NPI 1578865499

Title

Owner

Phone

(309) 662-8418

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 4

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.

• Jessica Bruin, D.C.

  • Chiropractor
  • Bloomington, IL
  • NPI 1578865499
  Medicare reassignment Care Compare group NPD Authorized official
• Megan Elysse Joseph, DC

  • Chiropractor
  • Bloomington, IL
  • NPI 1528856606
  Medicare reassignment Care Compare group NPD
• Katelyn Audrey Mendini, DC

  • Chiropractor
  • Bettendorf, IA
  • NPI 1396569612

  IL

  Medicare reassignment Care Compare group NPD
• Emmanuel Acheampong Kamara, D.C.

  • Chiropractor
  • Des Plaines, IL
  • NPI 1518420173
  NPD (past)

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

{
    "created_epoch": "1475452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566864000000",
    "number": "1235688110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2710 E LINCOLN ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046010",
            "telephone_number": "309-662-8418",
            "fax_number": "309-662-8197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 E LINCOLN ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046010",
            "telephone_number": "309-662-8418",
            "fax_number": "309-662-8197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTLAND LIFESTYLE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-03",
        "last_updated": "2019-08-27",
        "status": "A",
        "authorized_official_last_name": "BRUIN",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-662-8418",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tamara A Dyer
• Kiera Michelle Dymit
• East Central Illinois Area Agency on Aging, Inc.
• Eastland Chiropractic LTD
• Eastland Dental Center, LTD.
• Eastland Medical Plaza Surgicenter, LLC
• Eastland Open MRI LLC
• Eastland Psychological Services, LTD.
• Taylor Jolene Eastwood
• Mehrnoosh Ebadi

• Chiropractor in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2019; 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.