Nickolas William Severino, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038.013758 Issued in IL

Practice address

40 N Northwest Hwy
Park Ridge, IL 60068-3329

Phone

(847) 737-1023

Fax

(847) 737-1024

NPI assigned

Oct 22, 2021

Sex

Male

Sole proprietor

No

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

Specialty

Chiropractic

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Active Wellness LLCGroup PAC ID 3072752864, 21 clinicians

Practice addresses (Care Compare)

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.

• Active Wellness, LLC

  • Chiropractor
  • Chicago, IL
  • NPI 1902162662
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1634860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1376207795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 N NORTHWEST HWY",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600683329",
            "telephone_number": "847-737-1023",
            "fax_number": "847-737-1024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 N NORTHWEST HWY",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600683329",
            "telephone_number": "847-737-1023",
            "fax_number": "847-737-1024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEVERINO",
        "first_name": "NICKOLAS",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-22",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.013758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katarina Marie Semkiu, MD
• Benjamin Martin Sendo, PHARMD
• Yoolim Seo
• Nicholas Joseph Serafini, M.D.
• Marie A Serwa, APN
• Shana Sexton, LCSW
• Carrie Ann Shafer, R.D.
• Ami Shah, DO
• Bhaven Shah, MD
• Hemant B Shah, M.D.

• Chiropractor in Park Ridge, IL
• Providers in Park Ridge, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; 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.