Ican Clinic LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

ICAN CLINIC LLC

Practice address

441 S State Route 157 Ste 102
Edwardsville, IL 62025-4017

Phone

(618) 254-2273

Fax

(618) 254-8476

NPI assigned

Sep 14, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Michael S Harbison, DC

Title

Owner/Director

Phone

(618) 254-2273

Specialties & licenses 5

Addresses

Other names 1

• Wood River Chiropractic Doing business as

Locations

Practitioners 2

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

• Brent Lyerly, D.C.

  • Chiropractor
  • Edwardsville, IL
  • NPI 1528767563
  NPD
• Laura Burton

  • Nurse Practitioner
  • Wood River, IL
  • NPI 1417410200
  NPD (past)

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

{
    "created_epoch": "1347580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659484800000",
    "number": "1669722872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "441 S STATE ROUTE 157 STE 102",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620254017",
            "telephone_number": "618-254-2273",
            "fax_number": "618-254-8476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "441 S STATE ROUTE 157 STE 102",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620254017",
            "telephone_number": "618-254-2273",
            "fax_number": "618-254-8476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "203 E Ferguson Ave",
            "address_purpose": "LOCATION",
            "city": "Wood River",
            "state": "IL",
            "postal_code": "620952001",
            "country_code": "US",
            "telephone_number": "618-254-2273",
            "fax_number": "618-254-8476",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ICAN CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-14",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A",
        "authorized_official_last_name": "HARBISON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "618-254-2273",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.12178",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wood River Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wood River Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Natalie J. Hutchison, O.D.
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• David W Hyten, DMD
• Kenneth Charles Hyten
• Steven Joseph Hyten, DMD,MS
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• Jeannette Ineza
• Integrated Medical Group
• Integrated Medical Group LTD
• Integrated Medical Group LTD

• Multi-Specialty Clinic/Center in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Multi-Specialty Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; 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.