Sean Fitzpatrick Gibbs, B.S., D.C.
Individual provider Active NPI Chiropractor · Seneca, IL
NPI 1619989241 · NPPES record last updated Nov 29, 2018
Key facts
- NPI
- 1619989241
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038-008768 (IL)
- Practice address
- 260 So. Main St.
Seneca, IL 61360 - Phone
- (815) 357-6858
- Fax
- (815) 357-6857
- NPI assigned
- Aug 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 1999
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Riverside Chiropractic Center of Seneca,LTD.
Practice addresses (Care Compare)
260 S Main St
Seneca, IL 61360-9414
Phone (815) 357-6858
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111208000099 | IL | Practitioner - Chiropractic | 9133394174 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038-008768 | IL | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riverside Chiropractic Center of Seneca,LTD. | Chiropractor | Current |
Accepting new patients |
Locations
260 S Main St
Seneca, IL 61360
Phone (815) 357-6858
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038-008768 | IL | Yes |
Addresses
Primary practice location
260 So. Main St.
Seneca, IL 61360
Mailing address
260 So. Main St.
Seneca, IL 61360
Phone (815) 357-6858
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 038008768 | Medicaid | IL | |
| 05023003 | Other | IL | BCBSIL PROVIDER # |
Other providers in Seneca, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.