Critter Chiropractic Inc.
Organization Active NPI Chiropractor · Centralia, IL
NPI 1821234154 · NPPES record last updated Feb 6, 2024
Key facts
- NPI
- 1821234154
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- CRITTER CHIROPRACTIC INC.
- Practice address
- 211 S Perrine Ave
Centralia, IL 62801-3635 - Phone
- (618) 533-2225
- NPI assigned
- Dec 16, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Stephanie Kay Shook, DC
- Title
- President
- Phone
- (618) 533-2225
Practitioners 3
-
Stephanie Kay Shook, D.C.
-
Paul S Havrilka III, APRN, FNP-C
-
Dana Lee Mathis, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160923000372 | IL | Part B Supplier - Clinic/Group Practice | 7214090224 |
Receives reassigned benefits from 1 practitioner Practice locations: Centralia, IL |
National Provider Directory
Locations
211 S Perrine Ave
Centralia, IL 62801
Phone (618) 419-0011
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | Yes |
Addresses
Primary practice location
211 S Perrine Ave
Centralia, IL 62801-3635
Mailing address
211 S Perrine Ave
Centralia, IL 62801-3635
Phone (618) 533-2225
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W22349 | Other | WY | MEDICARE PTAN |
| W22350 | Other | WY | MEDICARE PTAN |
Other names
- Simply Chiropractic Inc.
Other providers in Centralia, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.