Individual provider Active NPI

Charles Ibrahim Fino, DC

  • Chiropractor
  • Palos Heights, IL
National Provider Identifier
1366739492
Registry record updated Sep 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038011963 Issued in IL
Practice address
12709 S Ridgeland Ave
Palos Heights, IL 60463-2242
Phone
(708) 926-2854
NPI assigned
Jul 10, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038011963 IL Primary

Addresses

Primary practice location

12709 S Ridgeland Ave
Palos Heights, IL 60463-2242

Mailing address

12709 S Ridgeland Ave
Palos Heights, IL 60463-2242
Phone (708) 926-2854

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111019000114 IL Practitioner - Chiropractic 8123290079 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 2011
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

12709 S Ridgeland Ave
Palos Heights, IL 60463-2242
Phone (708) 926-2854

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038011963ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Fino Family Chiropractic & Wellness S.C. Chiropractor CurrentSince May 14, 2015 Accepting new patients
Brannigan Chiropractic Center Chiropractor PastSince Jan 6, 2020 Accepting new patients

Locations

12709 S Ridgeland Ave
Palos Heights, IL 60463
Phone (708) 289-2769

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": "1310256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475107200000",
    "number": "1366739492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12709 S RIDGELAND AVE",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604632242",
            "telephone_number": "708-926-2854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12709 S RIDGELAND AVE",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604632242",
            "telephone_number": "708-926-2854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FINO",
        "first_name": "CHARLES",
        "middle_name": "IBRAHIM",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-10",
        "last_updated": "2016-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038011963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palos Heights, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; 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.