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Organization Active NPI

Southern Illinois Chiropractic Kinesiologypc

Doing business as Osborne Chiropractic PC

  • Chiropractor
  • O'Fallon, IL
National Provider Identifier
1376620260
Registry record updated May 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-009255 Issued in IL
Legal business name
SOUTHERN ILLINOIS CHIROPRACTIC KINESIOLOGYPC
Doing business as
Osborne Chiropractic PC
Osborne Family Chiropractic
Practice address
4965 Stone Falls Center
Suite 7
O Fallon, IL 62269-7803
Phone
(618) 622-9780
Fax
(618) 622-9782
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2023

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

Authorized official

Name
Dr. Corey Alan Osborne, DC, DIBAK, DCBCN, DCNPI 1124040688
Title
Owner/President/Chiropractor
Phone
(618) 622-9780

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 038-009255 IL Primary

Addresses

Primary practice location

4965 Stone Falls Center
Suite 7
O Fallon, IL 62269-7803

Mailing address

4965 Stone Falls Center
Suite 7
O Fallon, IL 62269-7803
Phone (618) 622-9780

Other identifiers 2

IdentifierTypeStateIssuer
03227051OtherILPROVIDER #
462042OtherILPROVIDER #

Other names 2

  • Osborne Chiropractic PC Doing business as
  • Osborne Family Chiropractic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050520000729 IL Part B Supplier - Clinic/Group Practice 7214978113 Receives reassigned benefits from 3 practitioners
Practice locations: O Fallon, IL

National Provider Directory

National Provider Directory

Locations

734 Cambridge Blvd
#100
O Fallon, IL 62269
Phone (618) 401-7362

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684454400000",
    "number": "1376620260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4965 STONE FALLS CENTER",
            "address_2": "SUITE 7",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697803",
            "telephone_number": "618-622-9780",
            "fax_number": "618-622-9782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4965 STONE FALLS CENTER",
            "address_2": "SUITE 7",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697803",
            "telephone_number": "618-622-9780",
            "fax_number": "618-622-9782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS CHIROPRACTIC KINESIOLOGYPC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A",
        "authorized_official_last_name": "OSBORNE",
        "authorized_official_first_name": "COREY",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT/CHIROPRACTOR",
        "authorized_official_telephone_number": "618-622-9780",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC, DIBAK, DCBCN, DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-009255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER #",
            "identifier": "03227051",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER #",
            "identifier": "462042",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Osborne Chiropractic PC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Osborne Family Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Osborne Family Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in O'Fallon, IL

Sources for this page

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