North Shore Pro-Active Health LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038-010764 Issued in IL

Legal business name

NORTH SHORE PRO-ACTIVE HEALTH LLC

Practice address

112 W Lake St
Libertyville, IL 60048-1812

Phone

(847) 362-4476

Fax

(847) 367-5339

NPI assigned

Jun 29, 2009

Last updated

Mar 3, 2015By 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. Jordan L Leasure, DCNPI 1568563054

Title

Doctor

Phone

(847) 362-4476

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

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.

• Jordan Leasure, D.C.

  • Chiropractor
  • Libertyville, IL
  • NPI 1568563054
  Medicare reassignment NPD Authorized official
• Jade Ashley Dellinger, D.C

  • Chiropractor
  • Libertyville, IL
  • NPI 1932420510
  NPD (past)

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425340800000",
    "number": "1780812784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 W LAKE ST",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600481812",
            "telephone_number": "847-362-4476",
            "fax_number": "847-367-5339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 W LAKE ST",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600481812",
            "telephone_number": "847-362-4476",
            "fax_number": "847-367-5339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE PRO-ACTIVE HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-29",
        "last_updated": "2015-03-03",
        "status": "A",
        "authorized_official_last_name": "LEASURE",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "847-362-4476",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-010764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Norbeck, D.P.T.
• North Shore Brain and Body Inc
• North Shore Oncology-Hematology Associates, LTD.
• North Shore Physical Medical Group, SC
• North Shore Primary Care S.C.
• North Shore Surgical Associates, S.C.
• North Suburban Family Physicians SC (North Suburban Family Physicians)
• North Suburban Health Care LTD
• Northland Hearing Center, Inc.
• Northland Hearing Centers, Inc.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2015; 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.