NPIMap

Organization Active NPI

Chirom-Med LTD

  • Chiropractor
  • Belleville, IL
National Provider Identifier
1396866091
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
CHIROM-MED LTD
Practice address
3200 W Main St
Belleville, IL 62226-6620
Phone
(618) 235-3200
Fax
(618) 235-3282
NPI assigned
Apr 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Susan Elaine Ivy, B.A.
Title
Office Manager
Phone
(618) 235-3200

Specialties & licenses 1

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

Addresses

Primary practice location

3200 W Main St
Belleville, IL 62226-6620

Mailing address

3200 W Main St
Belleville, IL 62226-6620
Phone (618) 235-3200

Other identifiers 4

IdentifierTypeStateIssuer
40000221OtherILUHC ID#
400198OtherILHELATHLINK ID#
7138280OtherILAETNA ID#
142955OtherILCOVENTRY ID#

National Provider Directory

National Provider Directory
Tax ID family
Chirom-Med LTD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3200 W Main St
Belleville, IL 62226
Phone (618) 235-3200

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396866091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 W MAIN ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622266620",
            "telephone_number": "618-235-3200",
            "fax_number": "618-235-3282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 W MAIN ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622266620",
            "telephone_number": "618-235-3200",
            "fax_number": "618-235-3282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIROM-MED LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "IVY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "618-235-3200",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "B.A."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC ID#",
            "identifier": "40000221",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HELATHLINK ID#",
            "identifier": "400198",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA ID#",
            "identifier": "7138280",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY ID#",
            "identifier": "142955",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.