Michael James Gergovich, D.C.
Individual provider Active NPI Chiropractor · La Salle, IL
NPI 1295032084 · NPPES record last updated Oct 16, 2018
Key facts
- NPI
- 1295032084
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038011831 (IL)
- Practice address
- 130 3Rd St
La Salle, IL 61301-2312 - Phone
- (815) 223-0647
- Fax
- (815) 223-0987
- NPI assigned
- Feb 15, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - West Sunnyvale, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
130 3Rd St
La Salle, IL 61301-2312
Phone (815) 223-0647
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111205000539 | IL | Practitioner - Chiropractic | 0244405165 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gergovich Family Chiropractic, LLC. | Chiropractor | Current |
Accepting new patients |
| William L. Judge Chiropractic Center, PC | Chiropractor | Past |
Accepting new patients |
Locations
130 3rd St
La Salle, IL 61301
Phone (815) 223-0647
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038011831 | IL | Yes |
Addresses
Primary practice location
130 3Rd St
La Salle, IL 61301-2312
Mailing address
130 3Rd St
La Salle, IL 61301-2312
Phone (815) 223-0647
Other practice location 1
2232 Donahue St
LA Salle, IL 61301-1023
Phone (815) 228-8137
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619267135 | Other | IL | CHIROPRACTOR |
Other providers in La Salle, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.