Jared T. Liles, D.C.
Individual provider Active NPI Chiropractor · Lena, IL
NPI 1487981791 · NPPES record last updated Nov 6, 2009
Key facts
- NPI
- 1487981791
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038011548 (IL)
- Practice address
- 238 W Main St
Lena, IL 61048-9770 - Phone
- (815) 369-4974
- NPI assigned
- Nov 6, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - West Sunnyvale, 2009
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
238 W Main St
PO Box 424
Lena, IL 61048-9770
Phone (815) 369-4974
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100304000636 | IL | Practitioner - Chiropractic | 7113062936 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038011548 | IL | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038011548 | IL | Yes |
Addresses
Primary practice location
238 W Main St
Lena, IL 61048-9770
Mailing address
238 W Main St
P.O. Box 424
Lena, IL 61048-9770
Other providers in Lena, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.