Chiropractic Associates of Kankakee Inc
Organization Active NPI Clinic/Center · Manteno, IL
NPI 1649417593 · NPPES record last updated Oct 15, 2009
Key facts
- NPI
- 1649417593
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- License
- 038010846 (IL)
- Legal business name
- CHIROPRACTIC ASSOCIATES OF KANKAKEE INC
- Practice address
- 53 N Main St
Manteno, IL 60950-1534 - Phone
- (815) 468-7787
- Fax
- (815) 468-0154
- NPI assigned
- Jan 14, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Brent Wayne Adams, D.C.
- Title
- Chiropractic Physician / President
- Phone
- (815) 468-7787
Practitioners 4
-
Noel Cowart Davis Jr., D.C.
-
Dawn M Sample, DC
-
Michael W Sample, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090608000407 | IL | Part B Supplier - Clinic/Group Practice | 0840340121 |
Receives reassigned benefits from 1 practitioner Practice locations: Bradley, IL |
National Provider Directory
Locations
232 N Industrial Dr
Bradley, IL 60915
Phone (815) 614-3073
535 E North St
Ste A
Bradley, IL 60915
Phone (815) 614-3073
51 N Main St
Manteno, IL 60950
Phone (815) 468-7787
53 N Main St
Manteno, IL 60950
Phone (815) 468-7787
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 038010846 | IL | Yes |
Addresses
Primary practice location
53 N Main St
Manteno, IL 60950-1534
Mailing address
53 N Main St
Manteno, IL 60950-1534
Phone (815) 468-7787
Other providers in Manteno, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2009. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.