Active NPI
Shane Gerald McTague, DC
- Chiropractor
- Chicago, IL
National Provider Identifier
1497529218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 038.014073
- Practice address
- 4555 N Lincoln Ave
Chicago, IL 60625-2102 - Phone
- (815) 217-4964
- NPI assigned
- Nov 13, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038.014073 | IL | Primary |
Addresses
Primary practice location
4555 N Lincoln Ave
Chicago, IL 60625-2102
Mailing address
4555 N Lincoln Ave
Chicago, IL 60625-2102
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038.014073 | IL | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Form and Function PLLC | Chiropractor | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Chiropractor
- Chicago, IL
- NPI 1255263554
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1699833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699833600000",
"number": "1497529218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4555 N LINCOLN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606252102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4555 N LINCOLN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606252102",
"telephone_number": "815-217-4964"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCTAGUE",
"first_name": "SHANE",
"middle_name": "GERALD",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-11-13",
"last_updated": "2023-11-13",
"certification_date": "2023-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IL",
"license": "038.014073",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.