Old Town Chiropractic Center PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038006619 Issued in IL

Legal business name

OLD TOWN CHIROPRACTIC CENTER PC

Practice address

160 S Bloomingdale Rd
Suite D
Bloomingdale, IL 60108-1479

Phone

(630) 893-7313

Fax

(630) 893-7453

NPI assigned

Feb 1, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michael David Kelly, D.C.NPI 1124106596

Title

Chiropractic Owner

Phone

(630) 893-7313

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

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

• Michael David Kelly, DC

  • Chiropractor
  • Bloomingdale, IL
  • NPI 1124106596
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337731200000",
    "number": "1689712804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 S. BLOOMINGDALE RD.",
            "address_2": "SUITE D",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601081455",
            "telephone_number": "630-893-7313",
            "fax_number": "630-893-7453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 S BLOOMINGDALE RD",
            "address_2": "SUITE D",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601081479",
            "telephone_number": "630-893-7313",
            "fax_number": "630-893-7453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD TOWN CHIROPRACTIC CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2012-05-23",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "CHIROPRACTIC  OWNER",
        "authorized_official_telephone_number": "630-893-7313",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038006619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Bloomingdale, IL
• Providers in Bloomingdale, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2012; 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.