Active NPI
Gary D Tennant, D.C.
- Chiropractor
- Park Forest, IL
National Provider Identifier
1780653071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 038-005464
- Practice address
- 386 Forest Blvd
Park Forest, IL 60466-2005 - Phone
- (708) 481-1715
- Fax
- (708) 481-8915
- NPI assigned
- Mar 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038-005464 | IL | Primary |
Addresses
Primary practice location
386 Forest Blvd
Park Forest, IL 60466-2005
Mailing address
386 Forest Blvd
Park Forest, IL 60466-2005
Phone (708) 481-1715
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 350056091 | Other | IL | RR MEDICARE |
| 1622660 | Other | IL | BCBSIL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038-005464 | IL | MD | Chiropractor |
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 and National Provider Directory roles.
-
- Chiropractor
- Park Forest, IL
- NPI 1598734295
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200355200000",
"number": "1780653071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "386 FOREST BLVD",
"city": "PARK FOREST",
"state": "IL",
"postal_code": "604662005",
"telephone_number": "708-481-1715",
"fax_number": "708-481-8915"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "386 FOREST BLVD",
"city": "PARK FOREST",
"state": "IL",
"postal_code": "604662005",
"telephone_number": "708-481-1715",
"fax_number": "708-481-8915"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TENNANT",
"first_name": "GARY",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-17",
"last_updated": "2008-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IL",
"license": "038-005464",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "350056091",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSIL",
"identifier": "1622660",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Park Forest, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 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.