Revermann Chiropractic P.C.
Organization Active NPI Chiropractor · Breese, IL
NPI 1679679286 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1679679286
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- REVERMANN CHIROPRACTIC P.C.
- Practice address
- 397 N Plum St
Breese, IL 62230-1528 - Phone
- (618) 526-4134
- NPI assigned
- Sep 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Craig Alan Revermann, D.C.
- Title
- President
- Phone
- (618) 526-4700
Practitioners 5
-
Craig A. Revermann, D.C.
-
Angela Dawn Herndon, APN
-
Jamie Devon Stephens, D.C.
-
Jason Bollenbaugh, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061129000135 | IL | Part B Supplier - Clinic/Group Practice | 1153329172 |
Receives reassigned benefits from 1 practitioner Practice locations: Breese, IL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | IL | Yes |
Addresses
Primary practice location
397 N Plum St
Breese, IL 62230-1528
Mailing address
397 N Plum St
Breese, IL 62230-1528
Phone (618) 526-4134
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710984042 | Other | INDIVIDUAL NPI FOR CRAIG |
Other names
- Revermann Chiropractic and Spinal Rehabilitation
NPI Registry JSON
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1679679286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "397 N PLUM ST",
"city": "BREESE",
"state": "IL",
"postal_code": "622301528",
"telephone_number": "618-526-4134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "397 N PLUM ST",
"city": "BREESE",
"state": "IL",
"postal_code": "622301528",
"telephone_number": "618-526-4134"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "REVERMANN CHIROPRACTIC P.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-15",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "REVERMANN",
"authorized_official_first_name": "CRAIG",
"authorized_official_middle_name": "ALAN",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "618-526-4700",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.C."
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Chiropractor",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIVIDUAL NPI FOR CRAIG",
"identifier": "1710984042",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Revermann Chiropractic and Spinal Rehabilitation",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Breese, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.