NPIMap

Organization Active NPI

Vitalize Chiropractic: a Creating Wellness Center LLC

  • Chiropractor
  • Swansea, IL
National Provider Identifier
1639357726
Registry record updated Jun 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038.011081 Issued in IL
Legal business name
VITALIZE CHIROPRACTIC: A CREATING WELLNESS CENTER LLC
Practice address
4980 Benchmark Centre Dr
Suite 100
Swansea, IL 62226-2041
Phone
(618) 624-9080
Fax
(618) 624-9090
NPI assigned
Jan 31, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2008

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

Authorized official

Name
Dr. Leah Jeanne Killian, DC
Title
Owner
Phone
(618) 624-9080

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 038.011081 IL Primary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 38008365 IL

Addresses

Primary practice location

4980 Benchmark Centre Dr
Suite 100
Swansea, IL 62226-2041

Mailing address

4980 Benchmark Centre Dr
Suite 100
Swansea, IL 62226-2041
Phone (618) 624-9080

National Provider Directory

National Provider Directory

Locations

4980 Benchmark Centre Dr
Swansea, IL 62226
Phone (618) 624-9080

4980 Benchmark Centre Dr
Ste 100
Swansea, IL 62226
Phone (618) 624-9080

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1201737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1639357726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4980 BENCHMARK CENTRE DR",
            "address_2": "SUITE 100",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262041",
            "telephone_number": "618-624-9080",
            "fax_number": "618-624-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4980 BENCHMARK CENTRE DR",
            "address_2": "SUITE 100",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262041",
            "telephone_number": "618-624-9080",
            "fax_number": "618-624-9090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALIZE CHIROPRACTIC: A CREATING WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-31",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "KILLIAN",
        "authorized_official_first_name": "LEAH",
        "authorized_official_middle_name": "JEANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-624-9080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.011081",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "38008365",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Swansea, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.