Ridge Chiropractic Center, LTD.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038-009977 Issued in IL

Legal business name

RIDGE CHIROPRACTIC CENTER, LTD.

Practice address

434 W Mondamin St
Minooka, IL 60447-9875

Phone

(815) 467-1464

NPI assigned

May 3, 2007

Last updated

Sep 27, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Darren Cissell, D.C.NPI 1326091372

Title

Owner

Phone

(815) 467-1464

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, and the practitioner matching its NPPES authorized official.

• Darren Cissell, D.C.

  • Chiropractor
  • Minooka, IL
  • NPI 1326091372
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222473600000",
    "number": "1700098902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 W. MONDAMIN ST.",
            "city": "MINOOKA",
            "state": "IL",
            "postal_code": "60447",
            "telephone_number": "815-467-1464",
            "fax_number": "815-521-0492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 W MONDAMIN ST",
            "city": "MINOOKA",
            "state": "IL",
            "postal_code": "604479875",
            "telephone_number": "815-467-1464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDGE CHIROPRACTIC CENTER, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2008-09-27",
        "status": "A",
        "authorized_official_last_name": "CISSELL",
        "authorized_official_first_name": "DARREN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-467-1464",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-009977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2008; 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.