NPIMap

Organization Active NPI

Revermann Chiropractic P.C.

Doing business as Revermann Chiropractic and Spinal Rehabilitation

  • Chiropractor
  • Breese, IL
National Provider Identifier
1679679286
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
REVERMANN CHIROPRACTIC P.C.
Doing business as
Revermann Chiropractic and Spinal Rehabilitation
Practice address
397 N Plum St
Breese, IL 62230-1528
Phone
(618) 526-4134
NPI assigned
Sep 15, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Craig Alan Revermann, D.C.NPI 1710984042
Title
President
Phone
(618) 526-4700

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 IL Primary

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 names 1

  • Revermann Chiropractic and Spinal Rehabilitation Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061129000135 IL Part B Supplier - Clinic/Group Practice 1153329172 Receives reassigned benefits from 1 practitioner
Practice locations: Breese, IL

National Provider Directory

National Provider Directory

Locations

397 N Plum St
Breese, IL 62230
Phone (618) 526-4700

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "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": [],
    "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. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.