Ezequiel Maldonado-Vazquez

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

38013547 Issued in IL

Practice address

2325 Dean St Ste 800O
St Charles, IL 60175-4821

Phone

(331) 442-5140

Fax

(217) 954-0135

NPI assigned

May 5, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Mended Chiropractic LLC

  • Chiropractor
  • St Charles, IL
  • NPI 1790485357
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1588636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677801600000",
    "number": "1366063984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2325 DEAN ST STE 800O",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601754821",
            "telephone_number": "217-778-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2325 DEAN ST STE 800O",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601754821",
            "telephone_number": "331-442-5140",
            "fax_number": "217-954-0135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALDONADO-VAZQUEZ",
        "first_name": "EZEQUIEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-05-05",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "38013547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Magafas, PTA
• Rebecca Anne Magiera, LCSW, CADC
• Susie Maguire, LCPC
• Abigail Rose Mahonski, OTD, OTR/L
• Susan Marie Major, MA CCC CLP
• Faizal Malkana, PA-C
• Cezar Mallari, M.D
• Kelsey Mallon, M.A.
• Karen L Maloney, MD
• Hanora Malorny

• Chiropractor in St Charles, IL
• Providers in St Charles, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2023; 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.