Individual provider Active NPI

Laura J Schelly, DC

  • Chiropractor
  • Peoria, IL
National Provider Identifier
1689739492
Registry record updated Oct 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-006410 Issued in IL
Practice address
1200 W Loucks Ave
Peoria, IL 61604-2604
Phone
(309) 682-6624
Fax
(309) 682-6625
NPI assigned
Dec 22, 2006
Last updated
Oct 20, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038-006410 IL Primary

Addresses

Primary practice location

1200 W Loucks Ave
Peoria, IL 61604-2604

Mailing address

1208 W Loucks Ave
Peoria, IL 61604-2604
Phone (309) 682-6624

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071116000410 IL Practitioner - Chiropractic 9234227729 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4238 N Knoxville Ave
Peoria, IL 61614-7435
Phone (309) 282-6419

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038-006410ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Multicare, PC Chiropractor CurrentSince Aug 27, 2024 Accepting new patients
Schelly Chiropractic, Inc Chiropractor CurrentSince Jul 5, 2010 Accepting new patients

Locations

1208 W Loucks Ave
Peoria, IL 61604
Phone (309) 682-6624

4238 N Knoxville Ave
Peoria, IL 61614
Phone (309) 282-6419

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287532800000",
    "number": "1689739492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 W LOUCKS AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616042604",
            "telephone_number": "309-682-6624",
            "fax_number": "309-682-6625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W LOUCKS AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616042604",
            "telephone_number": "309-682-6624",
            "fax_number": "309-682-6625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHELLY",
        "first_name": "LAURA",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-22",
        "last_updated": "2010-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-006410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.