Individual provider Active NPI

Robert Dick Eaton, D.C.

  • Chiropractor
  • Du Quoin, IL
National Provider Identifier
1629189261
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Practice address
31 S Mulberry St
Du Quoin, IL 62832-1303
Phone
(618) 542-6680
Fax
(618) 542-6680
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X IL Primary

Addresses

Primary practice location

31 S Mulberry St
Du Quoin, IL 62832-1303

Mailing address

31 S Mulberry St
Du Quoin, IL 62832-1303
Phone (618) 542-6680

Other identifiers 1

IdentifierTypeStateIssuer
7323053OtherILBLUE CROSS PROVIDER NUMBE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090923000240 IL Practitioner - Chiropractic 1658427216 Receives reassigned benefits from 1 practitioner
Practice locations: Du Quoin, IL

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

31 S Mulberry St
Du Quoin, IL 62832-1303
Phone (618) 542-6680

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038008829ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Duquoin Chiropractic Center Chiropractor PastSince Jan 1, 1990 Accepting new patients

Practitioners & affiliated clinicians

Practitioners 1

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

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629189261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 S MULBERRY ST",
            "city": "DU QUOIN",
            "state": "IL",
            "postal_code": "628321303",
            "telephone_number": "618-542-6680",
            "fax_number": "618-542-6680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 S MULBERRY ST",
            "city": "DU QUOIN",
            "state": "IL",
            "postal_code": "628321303",
            "telephone_number": "618-542-6680",
            "fax_number": "618-542-6680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EATON",
        "first_name": "ROBERT",
        "middle_name": "DICK",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "7323053",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Du Quoin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.