Michael Scott Smith, D.C.

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

038-008658 Issued in IL

Practice address

108 S Franklin St
Dwight, IL 60420-1345

Phone

(815) 584-2225

NPI assigned

Feb 27, 2007

Last updated

Apr 21, 2020By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587427200000",
    "number": "1376670430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 151",
            "city": "DWIGHT",
            "state": "IL",
            "postal_code": "604200151",
            "telephone_number": "815-584-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 S FRANKLIN ST",
            "city": "DWIGHT",
            "state": "IL",
            "postal_code": "604201345",
            "telephone_number": "815-584-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "name_prefix": "Mr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "IL",
            "license": "038-008658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "03223254",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "551250",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark A Passerman, DO
• Saint James Hospital (OSF Healthcare - Medical Group - Dwight)
• Maulin G Shah, D.O.
• Louis Shicker, MD
• Shopko Stores Operating Co LLC (Shopko Pharmacy 641)
• Ericka L Stemple, COTA/L
• Dennis Edward Strobel, M.D.
• Travis Swink
• Melissa Townsend Trevino, PHARMD
• Suresh Vade, MD

• Rehabilitation Chiropractor in Dwight, IL
• Providers in Dwight, IL by specialty
• Rehabilitation Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; 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.