Individual provider Active NPI

Alksander Spanya Odisho, D.C.

  • Chiropractor
  • Chicago, IL
National Provider Identifier
1285741595
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-008357 Issued in IL
Practice address
3344 W Peterson Ave Ste 101
Chicago, IL 60659-3531
Phone
(773) 866-1234
Fax
(773) 866-1282
NPI assigned
Aug 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038-008357 IL Primary

Addresses

Primary practice location

3344 W Peterson Ave Ste 101
Chicago, IL 60659-3531

Mailing address

3344 W Peterson Ave Ste 101
Chicago, IL 60659-3531
Phone (773) 866-1234

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050328000973 IL Practitioner - Chiropractic 0042266538 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038-008357ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Pro Health Medical Group Chiropractor CurrentSince Jan 1, 2005 Accepting new patients

Locations

3344 W Peterson Ave
Ste 101
Chicago, IL 60659
Phone (773) 245-3222

4444 Oakton St
Skokie, IL 60076
Phone (847) 983-8474

Organizations & group practices 1

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": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285741595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3344 W PETERSON AVE STE 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606593531",
            "telephone_number": "773-866-1234",
            "fax_number": "773-866-1282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3344 W PETERSON AVE STE 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606593531",
            "telephone_number": "773-866-1234",
            "fax_number": "773-866-1282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODISHO",
        "first_name": "ALKSANDER",
        "middle_name": "SPANYA",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-008357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.