Healthsource of Deer Park

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038007087 Issued in IL

Legal business name

HEALTHSOURCE OF DEER PARK

Practice address

20876 N Rand Rd
Deer Park, IL 60010-3707

Phone

(847) 726-0044

NPI assigned

Nov 16, 2007

Last updated

Nov 9, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. J. Grant Reffell, D.C.

Title

Owner

Phone

(847) 726-0044

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415491200000",
    "number": "1669653770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20876 N RAND RD",
            "city": "DEER PARK",
            "state": "IL",
            "postal_code": "600103707",
            "telephone_number": "847-726-0044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20876 N RAND RD",
            "city": "DEER PARK",
            "state": "IL",
            "postal_code": "600103707",
            "telephone_number": "847-726-0044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE OF DEER PARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-16",
        "last_updated": "2014-11-09",
        "status": "A",
        "authorized_official_last_name": "REFFELL",
        "authorized_official_first_name": "J.",
        "authorized_official_middle_name": "GRANT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-726-0044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038007087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "490-50-20",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Claudyn Eguia, FNP-C
• Sonya Nichole Ephraim, M.D.
• Dominno Caroline Fogle, M.M.S., PA-C
• Irina Frenkel, MSN, FNP-BC
• Liliana Rose Geati
• Holland Therapy Group
• Danesha Howard, FNP-BC
• Tyler Huang
• Jay Joshi, M.D.
• Haley Kaimakis, LCPC

• Chiropractor in Deer Park, IL
• Providers in Deer Park, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2014; 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.