Jessica Anna Basala, DC
Individual provider Active NPI Chiropractor · Mokena, IL
NPI 1245375344 · NPPES record last updated Jun 3, 2016
Key facts
- NPI
- 1245375344
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038011189 (IL)
- Practice address
- 19636 S la Grange Rd
Mokena, IL 60448-9321 - Phone
- (708) 478-5822
- NPI assigned
- Feb 20, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038011189 | IL | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chiro One Wellness Center of Forest Park LLC | Chiropractor | Past |
Accepting new patients |
| Chiro One Wellness Center of St. Charles LLC | Chiropractor | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038011189 | IL | Yes |
Addresses
Primary practice location
19636 S la Grange Rd
Mokena, IL 60448-9321
Mailing address
2625 Butterfield Rd
Ste 301N
Oak Brook, IL 60523-1234
Phone (630) 320-6400
Other providers in Mokena, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.