Stassi Chiropractic & Wellness Center LLC
Organization Active NPI Chiropractor · Bethalto, IL
NPI 1508302985 · NPPES record last updated Jan 10, 2017
Key facts
- NPI
- 1508302985
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038012925 (IL)
- Legal business name
- STASSI CHIROPRACTIC & WELLNESS CENTER LLC
- Practice address
- 112 W Bethalto Blvd
Bethalto, IL 62010-1703 - Phone
- (618) 717-0621
- Fax
- (618) 717-0622
- NPI assigned
- Jan 10, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Kory J Stassi, D.C.
- Title
- Owner
- Phone
- (618) 717-0621
Practitioners 3
-
Amber Jo Miller, DC
-
Kory Stassi, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170301002521 | IL | Part B Supplier - Clinic/Group Practice | 1355625799 |
Receives reassigned benefits from 3 practitioners Practice locations: Bethalto, IL |
National Provider Directory
Locations
112 W Bethalto Blvd
Bethalto, IL 62010
Phone (618) 304-6360
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 038012925 | IL | Yes |
Addresses
Primary practice location
112 W Bethalto Blvd
Bethalto, IL 62010-1703
Mailing address
112 W Bethalto Blvd
Bethalto, IL 62010-1703
Phone (618) 717-0621
Other providers in Bethalto, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2017. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.