Nathan Evan Wiedrich, DC

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

038.010896 Issued in IL

Practice address

2031 E Grand Ave Ste 301
Lindenhurst, IL 60046-9094

Phone

(843) 906-0090

Fax

(843) 906-0090

NPI assigned

Mar 30, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in SC, IL2 enrollments

Enrollment records 2

Specialty

Chiropractic

Education

Palmer College Chiropractic - West Sunnyvale, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• JLDC Inc.

  • Rehabilitation Chiropractor
  • Lindenhurst, IL
  • NPI 1629576954
  Medicare reassignment Authorized official
• Joli LLC

  • Chiropractor
  • Charleston, SC
  • NPI 1316260805
  NPD (past)
• Meca Mentality LLC

  • Chiropractor
  • Charleston, SC
  • NPI 1457874174
  NPD (past)
• Wiedrich LLC

  • Chiropractor
  • Charleston, SC
  • NPI 1346414950
  NPD (past)

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1467572628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2031 E GRAND AVE STE 301",
            "city": "LINDENHURST",
            "state": "IL",
            "postal_code": "600469094",
            "telephone_number": "843-906-0090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2031 E GRAND AVE STE 301",
            "city": "LINDENHURST",
            "state": "IL",
            "postal_code": "600469094",
            "telephone_number": "843-906-0090",
            "fax_number": "843-906-0090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1175 Folly Road",
            "address_2": "Suite 9",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294124130",
            "country_code": "US",
            "telephone_number": "843-906-7232",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIEDRICH",
        "first_name": "NATHAN",
        "middle_name": "EVAN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-30",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "3342",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "3801096",
            "primary": false
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "IL",
            "license": "038.010896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Waukegan Clinic Corp
• Waukegan Illinois Hospital Company LLC
• Waukegan Illinois Hospital Company, LLC
• Jeffrey Wells
• Cori Michelle Wiedrich, DC
• Madelyn Alice Wilkinson
• Adam Giles Witt, DPT, PT, CSCS
• Stewart M Wurtz, LMT
• Wyant Pediatric Therapy Services, Inc.
• Julie K Wyant, OTR

• Rehabilitation Chiropractor in Lindenhurst, IL
• Providers in Lindenhurst, IL by specialty
• Rehabilitation Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.