Elk Trail Chiropractic Clinic LTD

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038008501 Issued in IL

Legal business name

ELK TRAIL CHIROPRACTIC CLINIC LTD

Practice address

2100 Manchester Rd
BLDG B Ste 1075B
Wheaton, IL 60187

Phone

(630) 221-9700

Fax

(630) 221-9704

NPI assigned

May 14, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Maryann Tadros, DCNPI 1336149681

Title

Owner

Phone

(630) 221-9700

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.

• Maryann Tadros, DC

  • Chiropractor
  • Wheaton, IL
  • NPI 1336149681
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613692800000",
    "number": "1841405628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 N MAIN ST",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601873581",
            "telephone_number": "630-221-9700",
            "fax_number": "630-221-9704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 MANCHESTER RD",
            "address_2": "BLDG B STE 1075B",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "60187",
            "telephone_number": "630-221-9700",
            "fax_number": "630-221-9704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELK TRAIL CHIROPRACTIC CLINIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A",
        "authorized_official_last_name": "TADROS",
        "authorized_official_first_name": "MARYANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-221-9700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038008501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Elbrecht, LCPC
• Gulsu Nur Eldek
• Eliane G. Stefango, Ma, LCPC, NCC
• Calvin D. Elifson, LCPC
• Elite Stat Lab Solutions LLC
• Joshua Serle Elliott
• Nicole Christine Elliott
• Rachael Loretta Elmore
• Embolden Clinical Services
• Brenna Michele Embretson, MA, LPC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; 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.