NPIMap

Organization Active NPI

Komeshak Chiropractic LTD

  • Chiropractor
  • Belleville, IL
National Provider Identifier
1437249158
Registry record updated Feb 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038008047 Issued in IL
Legal business name
KOMESHAK CHIROPRACTIC LTD
Practice address
3030 Frank Scott Pkwy W
Suite 1
Belleville, IL 62223-5014
Phone
(618) 236-3600
Fax
(618) 236-3600
NPI assigned
Oct 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2011

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

Authorized official

Name
Patrick Komeshak, DC
Title
Owner
Phone
(618) 236-3600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 038008047 IL Primary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 070011807 IL

Addresses

Primary practice location

3030 Frank Scott Pkwy W
Suite 1
Belleville, IL 62223-5014

Mailing address

3030 Frank Scott Pkwy W
Suite 1
Belleville, IL 62223-5014
Phone (618) 236-3600

Other identifiers 3

IdentifierTypeStateIssuer
DD4196OtherMEDICARE RAILROAD
104259OtherGHP
08221308OtherILBCBS ILLINOIS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298592000000",
    "number": "1437249158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 FRANK SCOTT PKWY W",
            "address_2": "SUITE 1",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622235014",
            "telephone_number": "618-236-3600",
            "fax_number": "618-236-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 FRANK SCOTT PKWY W",
            "address_2": "SUITE 1",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622235014",
            "telephone_number": "618-236-3600",
            "fax_number": "618-236-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOMESHAK CHIROPRACTIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2011-02-25",
        "status": "A",
        "authorized_official_last_name": "KOMESHAK",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-236-3600",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038008047",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070011807",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DD4196",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP",
            "identifier": "104259",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ILLINOIS",
            "identifier": "08221308",
            "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 Feb 25, 2011; 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.