NPIMap

Organization Active NPI

Peoria Chiropractic PC

  • Chiropractor
  • Peoria, IL
National Provider Identifier
1457537508
Registry record updated Jul 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038007166 Issued in IL
Legal business name
PEORIA CHIROPRACTIC PC
Practice address
2015 W Glen Ave
Suite 220
Peoria, IL 61614-4690
Phone
(309) 693-1212
Fax
(309) 693-2147
NPI assigned
Jan 18, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2008

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

Authorized official

Name
Dr. Ryder Church, DC
Title
Doctor
Phone
(309) 693-1212

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 038007166 IL Primary

Addresses

Primary practice location

2015 W Glen Ave
Suite 220
Peoria, IL 61614-4690

Mailing address

2015 W Glen Ave
Suite 220
Peoria, IL 61614-4690
Phone (309) 693-1212

Other identifiers 1

IdentifierTypeStateIssuer
038007166MedicaidIL

National Provider Directory

National Provider Directory

Locations

5009 N Glen Park Place Rd
Peoria, IL 61614
Phone (309) 683-8170

Practitioners & affiliated clinicians

Practitioners 7

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": "1200614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1457537508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 W GLEN AVE",
            "address_2": "SUITE 220",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144690",
            "telephone_number": "309-693-1212",
            "fax_number": "309-693-2147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 W GLEN AVE",
            "address_2": "SUITE 220",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144690",
            "telephone_number": "309-693-1212",
            "fax_number": "309-693-2147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEORIA CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-18",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "CHURCH",
        "authorized_official_first_name": "RYDER",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "309-693-1212",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038007166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038007166",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jul 2, 2008; 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.