Leslie J Botta, D.C.
Individual provider Active NPI Chiropractor · Manteno, IL
NPI 1669744306 · NPPES record last updated Oct 16, 2020
Key facts
- NPI
- 1669744306
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038012127 (IL)
- Practice address
- 43 W Second St
Manteno, IL 60950-1240 - Phone
- (815) 200-4362
- NPI assigned
- Jan 26, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- National College of Chiropractic, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
43 W 2ND St
Manteno, IL 60950-1240
Phone (815) 200-4362
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120621000283 | IL | Practitioner - Chiropractic | 2365606423 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038012127 | IL | MD | Chiropractor |
| 007407-1 | NY | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Manteno Chiropractic & Wellness Center | Chiropractor | Current |
Accepting new patients |
Locations
43 W Second St
Manteno, IL 60950
Phone (815) 200-4362
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 007407-1 | NY | |
| Chiropractor | 111N00000X | 038012127 | IL | Yes |
Addresses
Primary practice location
43 W Second St
Manteno, IL 60950-1240
Mailing address
43 W Second St
Manteno, IL 60950-1240
Phone (815) 200-4362
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 16, 2020. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.