Mended Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

MENDED CHIROPRACTIC LLC

Practice address

2325 Dean St Ste 800O
St Charles, IL 60175-4821

Phone

(331) 442-5140

NPI assigned

Mar 3, 2023

Last updated

Mar 15, 2023By 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. Ezequiel Maldonado-Vazquez, DCNPI 1366063984

Title

Owner

Phone

(630) 715-0098

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

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.

• Ezequiel Maldonado-Vazquez

  • Chiropractor
  • St Charles, IL
  • NPI 1366063984
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1677801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678838400000",
    "number": "1790485357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2325 DEAN ST STE 800O",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601754821",
            "telephone_number": "331-442-5140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2325 DEAN ST STE 800O",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601754821",
            "telephone_number": "331-442-5140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDED CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-03",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A",
        "authorized_official_last_name": "MALDONADO-VAZQUEZ",
        "authorized_official_first_name": "EZEQUIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-715-0098",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in St Charles, IL
• Providers in St Charles, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; 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.