Samuel Hendricks, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038012554 Issued in IL

Practice address

2000 W Pioneer Pkwy
Suite 18a
Peoria, IL 61615-1835

Phone

(309) 670-2800

NPI assigned

Apr 22, 2014

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

Enrolled in IL

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Strong Roots Chiropractic LLC

  • Chiropractor
  • Eureka, IL
  • NPI 1568355089
  Medicare reassignment NPD Authorized official
• JD Nimrick PC

  • Physical Therapist
  • Peoria, IL
  • NPI 1336150283
  NPD (past)

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

{
    "created_epoch": "1398124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451952000000",
    "number": "1609296201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 W PIONEER PKWY",
            "address_2": "SUITE 18 A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616151835",
            "telephone_number": "309-670-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 W PIONEER PKWY",
            "address_2": "SUITE 18A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616151835",
            "telephone_number": "309-670-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKS",
        "first_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-22",
        "last_updated": "2016-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA-1598",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038012554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melinda Henderson, C-FNP
• Micah Jayne Henderson, RD, LDN
• Michala Henderson, DO
• Amber Hendricks
• Kathleen Marie Hendricks, APN
• David K Hendricksen, M.D.
• Jamie Hendrickson, MS, RDN, LDN
• Mena Henien, MD
• Jeffrey R Henline, OD
• Jesse Lee Henneberg, APN

• Chiropractor in Peoria, IL
• Providers in Peoria, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.