Individual provider Active NPI

Michael Donald Richards, D.C.

  • Chiropractor
  • Moline, IL
National Provider Identifier
1285711085
Registry record updated Sep 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-007687 Issued in IL
Practice address
1712 15TH Street PL
Moline, IL 61265-3961
Phone
(309) 797-5700
Fax
(309) 762-4645
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 19, 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 038-007687 IL Primary

Addresses

Primary practice location

1712 15TH Street PL
Moline, IL 61265-3961

Mailing address

1712 15TH Street PL
Moline, IL 61265-3961
Phone (309) 797-5700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070730000807 IL Practitioner - Chiropractic 8123129434 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1712 15TH St PL
Moline, IL 61265-3961
Phone (309) 797-5700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038-007687ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Quad Cities Wellness and Rehabilitation Center, LTD. Chiropractor CurrentSince Apr 26, 2005 Accepting new patients
Kennedy Chiropractic Center PC Chiropractor Past Accepting new patients

Locations

1712 15th Street Pl
Moline, IL 61265
Phone (309) 797-5700

Interoperability endpoints

  • Direct secure messaging: dr.mike@kc0017.direct.chirotouch.md

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348012800000",
    "number": "1285711085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1712 15TH STREET PL",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612653961",
            "telephone_number": "309-797-5700",
            "fax_number": "309-762-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1712 15TH STREET PL",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612653961",
            "telephone_number": "309-797-5700",
            "fax_number": "309-762-4645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDS",
        "first_name": "MICHAEL",
        "middle_name": "DONALD",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2012-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-007687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moline, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; 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.