Illume Chiropractic, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC.4491 Issued in OH

Legal business name

ILLUME CHIROPRACTIC, LLC

Practice address

305 Downtowner PLZ
Coshocton, OH 43812-1928

Phone

(740) 562-5600

NPI assigned

Mar 4, 2015

Organization subpart

No

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

Authorized official

Name

Tanner Dickerson, DC

Title

Chiropractor

Phone

(740) 562-5600

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1425427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454544000000",
    "number": "1497147177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1867 S 14TH ST",
            "city": "COSHOCTON",
            "state": "OH",
            "postal_code": "438122912",
            "telephone_number": "740-562-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 DOWNTOWNER PLZ",
            "city": "COSHOCTON",
            "state": "OH",
            "postal_code": "438121928",
            "telephone_number": "740-562-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUME CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-04",
        "last_updated": "2016-02-04",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "TANNER",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "740-562-5600",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OH",
            "license": "DC.4491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2016; 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.