Granite City Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

GRANITE CITY CHIROPRACTIC LLC

Practice address

3136 Nameoki Rd
Granite City, IL 62040-5013

Phone

(618) 452-2300

Fax

(618) 452-0373

NPI assigned

Jul 28, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Daniel Jason Miller, DCNPI 1104832294

Title

Doctor of Chiropractic

Phone

(618) 452-2300

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Daniel Jason Miller

  • Chiropractor
  • Granite City, IL
  • NPI 1104832294
  Medicare reassignment NPD Authorized official
• Tabitha Robin Ellsworth, D.C.

  • Chiropractor
  • Granite City, IL
  • NPI 1245532068
  NPD (past)

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528072451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 GEREMMA DR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630113334",
            "telephone_number": "314-283-8421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3136 NAMEOKI RD",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620405013",
            "telephone_number": "618-452-2300",
            "fax_number": "618-452-0373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANITE CITY CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "618-452-2300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "06026803",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alan Richard Gitersonke, DPM
• Glorious Beginnings Doula Services
• Erin Marie Goebel, RN PHRN
• Good Samaritan House of Granite City, Inc
• Krista L Gooding, PT
• Granite City Clinic Corp
• Granite City Clinic Corp
• Granite City Emergency Physicians LLC
• Granite City Eye Care, Inc.
• Granite City Home Care Services, LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.