Organization Active NPI

Meadowcrest Chiropractic, LTD.

  • Chiropractor
  • La Grange Park, IL
National Provider Identifier
1417046434
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
MEADOWCREST CHIROPRACTIC, LTD.
Practice address
48 E 31St St
La Grange Park, IL 60526-1024
Phone
(708) 354-8118
NPI assigned
Oct 11, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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. Crystal Jean Tollstam
Title
Office Manager
Phone
(708) 354-8118

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X IL Primary

Addresses

Primary practice location

48 E 31St St
La Grange Park, IL 60526-1024

Mailing address

48 E 31St St
La Grange Park, IL 60526-1024
Phone (708) 354-8118

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060403000013 IL Part B Supplier - Clinic/Group Practice 0345258380 Receives reassigned benefits from 1 practitioner
Practice locations: La Grange Park, IL

National Provider Directory

National Provider Directory

Locations

48 E 31st St
Ste 3
La Grange Pk, IL 60526
Phone (708) 354-8118

48 E 31st St
Ste 34
La Grange Pk, IL 60526
Phone (708) 354-8118

Practitioners & affiliated clinicians

Practitioners 1

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": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417046434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 E 31ST ST",
            "city": "LA GRANGE PARK",
            "state": "IL",
            "postal_code": "605261024",
            "telephone_number": "708-354-8118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 E 31ST ST",
            "city": "LA GRANGE PARK",
            "state": "IL",
            "postal_code": "605261024",
            "telephone_number": "708-354-8118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADOWCREST CHIROPRACTIC, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TOLLSTAM",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "708-354-8118",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grange Park, 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.
  • 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.