Individual provider Active NPI

Robert Leonard Andino, DC

  • Chiropractor
  • Rockford, IL
National Provider Identifier
1871588301
Registry record updated Jul 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038009900 Issued in IL
Practice address
1007 W Riverside Blvd
Rockford, IL 61103-2158
Phone
(815) 877-5575
Fax
(815) 877-5550
NPI assigned
Sep 12, 2005
Last updated
Jul 18, 2008By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 18, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038009900 IL Primary

Addresses

Primary practice location

1007 W Riverside Blvd
Rockford, IL 61103-2158

Mailing address

1007 W Riverside Blvd
Rockford, IL 61103-2158
Phone (815) 877-5575

Other identifiers 1

IdentifierTypeStateIssuer
1669453056OtherILFACILITY NPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040601001187 IL Practitioner - Chiropractic 2365424710 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2002
Medicare assignment
May accept Medicare assignment
Group practices
Andino Chiropractic Clinic PCGroup PAC ID 7810117405, 2 clinicians

Practice addresses (Care Compare)

7264 Argus Dr
Rockford, IL 61107-5837
Phone (815) 877-5575

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038009900ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Andino Chiropractic Clinic PC Chiropractor CurrentSince Apr 9, 2016 Accepting new patients
Spinal Rehabilitation and Wellness Clinic, LLC Chiropractor Past Accepting new patients
Neck to Back Rockford LLC Past Accepting new patients
Neck to Back Lake County LLC Chiropractor Past Accepting new patients

Locations

1007 W Riverside Blvd
Rockford, IL 61103
Phone (815) 877-5575

7264 Argus Dr
Rockford, IL 61107
Phone (815) 229-8690

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216339200000",
    "number": "1871588301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 W RIVERSIDE BLVD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611032158",
            "telephone_number": "815-877-5575",
            "fax_number": "815-877-5550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 W RIVERSIDE BLVD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611032158",
            "telephone_number": "815-877-5575",
            "fax_number": "815-877-5550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDINO",
        "first_name": "ROBERT",
        "middle_name": "LEONARD",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-12",
        "last_updated": "2008-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038009900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FACILITY NPI",
            "identifier": "1669453056",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.