NPIMap

Organization Active NPI

Shorewood Chiropractic Clinic

  • Chiropractor
  • Shorewood, IL
National Provider Identifier
1649444688
Registry record updated Apr 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038009514 Issued in IL
Legal business name
SHOREWOOD CHIROPRACTIC CLINIC
Practice address
102 W Jefferson St
Unit 1
Shorewood, IL 60404-9502
Phone
(815) 744-9201
Fax
(815) 744-9401
NPI assigned
Apr 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2008

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

Authorized official

Name
Dr. Nomon Thanadabouth, B.S., D.C.NPI 1356468391
Title
Owner
Phone
(815) 744-9201

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 038009514 IL Primary

Addresses

Primary practice location

102 W Jefferson St
Unit 1
Shorewood, IL 60404-9502

Mailing address

102 W Jefferson St
Unit 1
Shorewood, IL 60404-9502
Phone (815) 744-9201

National Provider Directory

National Provider Directory

Locations

102 W Jefferson St
Unit 1
Shorewood, IL 60404
Phone (815) 744-9201

Practitioners & affiliated clinicians

Practitioners 1

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": "1208822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1649444688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 W JEFFERSON ST",
            "address_2": "UNIT 1",
            "city": "SHOREWOOD",
            "state": "IL",
            "postal_code": "604049502",
            "telephone_number": "815-744-9201",
            "fax_number": "815-744-9401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 W JEFFERSON ST",
            "address_2": "UNIT 1",
            "city": "SHOREWOOD",
            "state": "IL",
            "postal_code": "604049502",
            "telephone_number": "815-744-9201",
            "fax_number": "815-744-9401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOREWOOD CHIROPRACTIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-22",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "THANADABOUTH",
        "authorized_official_first_name": "NOMON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-744-9201",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "B.S., D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038009514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shorewood, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 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.