Active NPI
Elaine Janet Wagner, DC
- Chiropractor
- Chicago, IL
National Provider Identifier
1417974395
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 038004140
- Practice address
- 6033 N Sheridan Rd # Cw04S-05
Chicago, IL 60660-3003 - Phone
- (773) 274-6827
- NPI assigned
- Jul 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038004140 | IL | Primary |
Addresses
Primary practice location
6033 N Sheridan Rd # Cw04S-05
Chicago, IL 60660-3003
Mailing address
6033 N Sheridan Rd # Cw04S-05
Chicago, IL 60660-3003
Phone (773) 274-6827
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101011000313 | IL | Practitioner - Chiropractic | 3274725130 | Practice locations: Evanston, IL |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038004140 | IL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1417974395",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6033 N SHERIDAN RD # CW04S-05",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606603003",
"telephone_number": "773-274-6827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6033 N SHERIDAN RD # CW04S-05",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606603003",
"telephone_number": "773-274-6827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "ELAINE",
"middle_name": "JANET",
"name_prefix": "Ms.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-16",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IL",
"license": "038004140",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.