Illinois Spine and Sport LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

ILLINOIS SPINE AND SPORT LLC

Practice address

2 Northfield PLZ Ste 100
Northfield, IL 60093-1217

Phone

(815) 228-0992

NPI assigned

Oct 4, 2021

Last updated

Oct 20, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jon Sebby, DCNPI 1588967079

Title

Owner/Chiropractor

Phone

(815) 228-0992

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jon Bradley Sebby, D.C.

  • Chiropractor
  • Northfield, IL
  • NPI 1588967079
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1633305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634688000000",
    "number": "1619649001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 NORTHFIELD PLZ STE 100",
            "city": "NORTHFIELD",
            "state": "IL",
            "postal_code": "600931217",
            "telephone_number": "847-957-8660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 NORTHFIELD PLZ STE 100",
            "city": "NORTHFIELD",
            "state": "IL",
            "postal_code": "600931217",
            "telephone_number": "815-228-0992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS SPINE AND SPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-04",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A",
        "authorized_official_last_name": "SEBBY",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "815-228-0992",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC LICENSE",
            "identifier": "038011836",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "www.zhealthehr.com",
            "affiliation": "N",
            "endpointDescription": "EHR software",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2 Northfield Plz Ste 100",
            "city": "Northfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600931217",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; 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.