Michael Wayne Childress, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038011140 Issued in IL

Practice address

217 E Broadway Blvd
Johnston City, IL 62951-1604

Phone

(618) 983-3900

Fax

(618) 983-3900

NPI assigned

Oct 11, 2007

Last updated

Jan 20, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232409600000",
    "number": "1518155886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 E BROADWAY BLVD",
            "city": "JOHNSTON CITY",
            "state": "IL",
            "postal_code": "629511604",
            "telephone_number": "618-983-3900",
            "fax_number": "618-983-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 E BROADWAY BLVD",
            "city": "JOHNSTON CITY",
            "state": "IL",
            "postal_code": "629511604",
            "telephone_number": "618-983-3900",
            "fax_number": "618-983-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILDRESS",
        "first_name": "MICHAEL",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-11",
        "last_updated": "2009-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038011140",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2007030809",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rochelle Addison
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• Gary J Bandy, RPH
• Bliss Haven, Inc.
• Ashley Jean Byrley, LPN
• Christopher Greater Area Rural Health Planning Corporation (Johnston City Community Health Center)
• Chrysalis Behavior Services
• Rheanne Collier, RN
• Carmella Jo Doss, P.A.
• Erica Renee Escue, PA-C

• Chiropractor in Johnston City, IL
• Providers in Johnston City, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2009; 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.