Active NPI
Kristi Kay Dieckmann, D.C., M.S.
- Rehabilitation Chiropractor
- O'Fallon, IL
National Provider Identifier
1720309768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Chiropractor
- License
- 038.011634
- Practice address
- 1210 Paragon Dr
Suite 1B
O Fallon, IL 62269-1773 - Phone
- (618) 973-5522
- NPI assigned
- Jun 14, 2010
- Last updated
- Jun 14, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Chiropractor | 111NR0400X | 038.011634 | IL | Primary |
| Rehabilitation Chiropractor | 111NR0400X | 2010003872 | MO |
Addresses
Primary practice location
1210 Paragon Dr
Suite 1B
O Fallon, IL 62269-1773
Mailing address
1210 Paragon Dr
Suite 1B
O Fallon, IL 62269-1773
Phone (618) 973-5522
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038.011634 | IL | MD | Rehabilitation Chiropractor |
| 2010003872 | MO | MD | Rehabilitation Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Spine & Sport Chiropractic | Rehabilitation | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Rehabilitation Chiropractor
- O'Fallon, IL
- NPI 1336460385
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276473600000",
"number": "1720309768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1210 PARAGON DR",
"address_2": "SUITE 1B",
"city": "O FALLON",
"state": "IL",
"postal_code": "622691773",
"telephone_number": "618-973-5522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1210 PARAGON DR",
"address_2": "SUITE 1B",
"city": "O FALLON",
"state": "IL",
"postal_code": "622691773",
"telephone_number": "618-973-5522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIECKMANN",
"first_name": "KRISTI",
"middle_name": "KAY",
"name_prefix": "Dr.",
"credential": "D.C., M.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-14",
"last_updated": "2010-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "111NR0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Rehabilitation",
"state": "IL",
"license": "038.011634",
"primary": true
},
{
"code": "111NR0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Rehabilitation",
"state": "MO",
"license": "2010003872",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O'Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.