Individual provider Active NPI

Mark Sirotinskiy, D.C.

  • Chiropractor
  • Crestwood, IL
National Provider Identifier
1730484783
Registry record updated Jan 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-011871 Issued in IL
Practice address
13657 Cicero Ave
Crestwood, IL 60445-1936
Phone
(708) 396-2500
Fax
(708) 396-8605
NPI assigned
Jan 24, 2011
Last updated
Jan 24, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038-011871 IL Primary

Addresses

Primary practice location

13657 Cicero Ave
Crestwood, IL 60445-1936

Mailing address

7711 W 159TH St
Suite 102
Tinley Park, IL 60477-1329
Phone (708) 532-8080

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
038-011871ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Acu-Med Integrative Medicine LLC CurrentSince Nov 3, 2019 Accepting new patients
Health on Earth Wellness Centers LLC Chiropractor PastSince Jul 11, 2007 Accepting new patients
Crestwood Chiropractic and Rehab Chiropractor Past Accepting new patients

Locations

1428 E Racine Ave
Waukesha, WI 53186
Phone (262) 269-5107

Organizations & group practices 3

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": "1295827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295827200000",
    "number": "1730484783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7711 W 159TH ST",
            "address_2": "SUITE 102",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604771329",
            "telephone_number": "708-532-8080",
            "fax_number": "708-532-8383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13657 CICERO AVE",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "604451936",
            "telephone_number": "708-396-2500",
            "fax_number": "708-396-8605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIROTINSKIY",
        "first_name": "MARK",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-24",
        "last_updated": "2011-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-011871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestwood, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.