NPIMap

Organization Active NPI

Khairallah Chiropractic PC

  • Chiropractor
  • Peoria, IL
National Provider Identifier
1457419566
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
KHAIRALLAH CHIROPRACTIC PC
Doing business as
JSK Chiropractic PC
Practice address
4501 N Sterling Ave
Suite 104
Peoria, IL 61615-3834
Phone
(309) 679-9575
NPI assigned
Dec 4, 2006
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
Dr. Joseph S Khairallah, D.C.NPI 1346308376
Title
President
Phone
(309) 679-9575

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

4501 N Sterling Ave
Suite 104
Peoria, IL 61615-3834

Mailing address

4501 N Sterling Ave
Suite 104
Peoria, IL 61615-3834
Phone (309) 679-9575

Other identifiers 1

IdentifierTypeStateIssuer
07232021OtherILBLUE CROSS BLUE SHIELD

Other names 1

  • JSK Chiropractic PC Doing business as

National Provider Directory

National Provider Directory

Locations

4501 N Sterling Ave
Ste 104
Peoria, IL 61615
Phone (309) 679-9575

4501 N Sterling Ave
Peoria, IL 61615
Phone (309) 679-9575

Practitioners & affiliated clinicians

Practitioners 3

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": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457419566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 N STERLING AVE",
            "address_2": "SUITE 104",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616153834",
            "telephone_number": "309-679-9575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 N STERLING AVE",
            "address_2": "SUITE 104",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616153834",
            "telephone_number": "309-679-9575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KHAIRALLAH CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KHAIRALLAH",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-679-9575",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "07232021",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JSK Chiropractic PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peoria, 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.