Individual provider Active NPI

Nicholas Peter Fotieo, D.C.

  • Sports Physician Chiropractor
  • Chicago, IL
National Provider Identifier
1881075216
Registry record updated Jun 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
038012805 Issued in IL
Practice address
19 S la Salle St
Suite #503
Chicago, IL 60603-1401
Phone
(312) 236-9355
Fax
(312) 236-9301
NPI assigned
Jun 11, 2015
Last updated
Jun 11, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician Chiropractor 111NS0005X 038012805 IL Primary

Addresses

Primary practice location

19 S la Salle St
Suite #503
Chicago, IL 60603-1401

Mailing address

19 S la Salle St
Suite #503
Chicago, IL 60603-1401
Phone (312) 236-9355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
038012805ILMDSports Physician Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Loop Chiropractic & Sports Injury Center Sports Physician Past Accepting new patients
Loop Chiropractic & Sports Injury Center, LTD. PastSince Jul 29, 2016 Accepting new patients

Organizations & group practices 2

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": "1433980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433980800000",
    "number": "1881075216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 S LA SALLE ST",
            "address_2": "SUITE #503",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606031401",
            "telephone_number": "312-236-9355",
            "fax_number": "312-236-9301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 S LA SALLE ST",
            "address_2": "SUITE #503",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606031401",
            "telephone_number": "312-236-9355",
            "fax_number": "312-236-9301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOTIEO",
        "first_name": "NICHOLAS",
        "middle_name": "PETER",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-11",
        "last_updated": "2015-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "IL",
            "license": "038012805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.