Individual provider Active NPI

John Klimediotis, D.C.

  • Chiropractor
  • Park Ridge, IL
National Provider Identifier
1457363533
Registry record updated Oct 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-008803 Issued in IL
Practice address
3 S Prospect Ave
Suite 8
Park Ridge, IL 60068-4177
Phone
(847) 296-0505
Fax
(848) 827-1037
NPI assigned
Aug 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038-008803 IL Primary

Addresses

Primary practice location

3 S Prospect Ave
Suite 8
Park Ridge, IL 60068-4177

Mailing address

3 S Prospect Ave
Suite 8
Park Ridge, IL 60068-4177
Phone (847) 296-0505

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040330001475 IL Practitioner - Chiropractic 7113815135 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038-008803ILMDChiropractor
038008803ILMDNutrition Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
John Klimediotis S.C. Chiropractor CurrentSince Feb 9, 2007 Accepting new patients
A K Health Center Inc PastSince Feb 1, 2004 Accepting new patients

Locations

3 S Prospect Ave
Park Ridge, IL 60068
Phone (773) 704-3920

3 S Prospect Ave
Ste 8
Park Ridge, IL 60068
Phone (847) 296-0505

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349395200000",
    "number": "1457363533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 S PROSPECT AVE",
            "address_2": "SUITE 8",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684177",
            "telephone_number": "847-296-0505",
            "fax_number": "848-827-1037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 S PROSPECT AVE",
            "address_2": "SUITE 8",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684177",
            "telephone_number": "847-296-0505",
            "fax_number": "848-827-1037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLIMEDIOTIS",
        "first_name": "JOHN",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2012-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-008803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2012; 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.