NPIMap

Organization Active NPI

Southern Illinois Medical Plaza SC

  • Chiropractor
  • Carbondale, IL
National Provider Identifier
1578746228
Registry record updated Sep 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038007699 Issued in IL
Legal business name
SOUTHERN ILLINOIS MEDICAL PLAZA SC
Practice address
2250 Reed Station Pkwy
Ste 305
Carbondale, IL 62901-3304
Phone
(618) 529-1943
Fax
(618) 549-2975
NPI assigned
Dec 17, 2007
Last updated
Sep 21, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2010

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

Authorized official

Name
Dr. Steven Patrick Barrett, D.C.
Title
President
Phone
(618) 529-1943

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038007699 IL Primary
Family Medicine Physician 207Q00000X 036093859 IL
Physical Therapist 225100000X
Massage Therapist 225700000X

Addresses

Primary practice location

2250 Reed Station Pkwy
Ste 305
Carbondale, IL 62901-3304

Mailing address

2250 Reed Station Pkwy
Carbondale, IL 62901
Phone (618) 529-1943

Other identifiers 1

IdentifierTypeStateIssuer
03932090OtherILBCBS OF IL GROUP

National Provider Directory

National Provider Directory

Locations

2250 Reed Station Pkwy
Ste 305
Carbondale, IL 62901
Phone (618) 457-4999

NPI Registry JSON

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

{
    "created_epoch": "1197849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285027200000",
    "number": "1578746228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2250 REED STATION PKWY",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "62901",
            "telephone_number": "618-529-1943",
            "fax_number": "618-549-2975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2250 REED STATION PKWY",
            "address_2": "STE 305",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013304",
            "telephone_number": "618-529-1943",
            "fax_number": "618-549-2975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS MEDICAL PLAZA SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-17",
        "last_updated": "2010-09-21",
        "status": "A",
        "authorized_official_last_name": "BARRETT",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-529-1943",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038007699",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036093859",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL GROUP",
            "identifier": "03932090",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2010; 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.