Active NPI
Koren Fuller
- Massage Therapist
- Coal Valley, IL
National Provider Identifier
1639019003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 227023901
- Practice address
- 102 W 1St Ave
Coal Valley, IL 61240-9308 - Phone
- (309) 799-7422
- NPI assigned
- Mar 28, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 227023901 | IL | Primary |
Addresses
Primary practice location
102 W 1St Ave
Coal Valley, IL 61240-9308
Mailing address
401 Walnut St
Port Byron, IL 61275-9559
Phone (309) 644-9252
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 227023901 | IL | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coal Valley Chiropractic Clinic, Inc. | Past | Accepting new patients |
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.
-
- Chiropractor
- Coal Valley, IL
- NPI 1154504793
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1774656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774656000000",
"number": "1639019003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 WALNUT ST",
"city": "PORT BYRON",
"state": "IL",
"postal_code": "612759559",
"telephone_number": "309-644-9252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 W 1ST AVE",
"city": "COAL VALLEY",
"state": "IL",
"postal_code": "612409308",
"telephone_number": "309-799-7422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "KOREN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-03-28",
"last_updated": "2026-03-28",
"certification_date": "2026-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IL",
"license": "227023901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coal Valley, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.