Individual provider Active NPI

Danielle S Dever, DC

  • Chiropractor
  • Chicago, IL
National Provider Identifier
1760598775
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038010458 Issued in IL
Practice address
122 S Michigan Ave
Suite 1560
Chicago, IL 60603-6191
Phone
(312) 939-4121
Fax
(312) 939-8011
NPI assigned
Aug 22, 2006
Last updated
Nov 20, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038010458 IL Primary

Addresses

Primary practice location

122 S Michigan Ave
Suite 1560
Chicago, IL 60603-6191

Mailing address

122 S Michigan Ave
Suite 1560
Chicago, IL 60603-6191
Phone (312) 939-4121

Other identifiers 2

IdentifierTypeStateIssuer
038010458OtherILST LIC NO
200765OtherILGROUP MEDICARE PIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060123000970 IL Practitioner - Chiropractic 3476577925 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Active Wellness LLCGroup PAC ID 3072752864, 21 clinicians

Practice addresses (Care Compare)

4555 N Lincoln Ave
Chicago, IL 60625-2102
Phone (847) 791-7012

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038010458ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Functional Health SC Chiropractor PastSince Feb 1, 2015 Accepting new patients
Active Wellness, LLC Chiropractor Past Accepting new patients
Rosenthal Clinic SC Past Accepting new patients
Millenium Park Medical Center, SC Chiropractor PastSince May 1, 2013 Accepting new patients

Organizations & group practices 5

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": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195516800000",
    "number": "1760598775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 S MICHIGAN AVE",
            "address_2": "SUITE 1560",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606036191",
            "telephone_number": "312-939-4121",
            "fax_number": "312-939-8011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 S MICHIGAN AVE",
            "address_2": "SUITE 1560",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606036191",
            "telephone_number": "312-939-4121",
            "fax_number": "312-939-8011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVER",
        "first_name": "DANIELLE",
        "middle_name": "S",
        "name_prefix": "Ms.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-22",
        "last_updated": "2007-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038010458",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ST LIC NO",
            "identifier": "038010458",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE PIN",
            "identifier": "200765",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; 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.