NPIMap

Organization Active NPI

Vercellino Purchasing Co

Doing business as Decatur Back and Neck Center

  • Chiropractor
  • Decatur, IL
National Provider Identifier
1881152288
Registry record updated Mar 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
VERCELLINO PURCHASING CO
Doing business as
Decatur Back and Neck Center
Practice address
3350 N Water St Ste a
Decatur, IL 62526-2353
Phone
(217) 877-2404
Fax
(217) 877-2522
NPI assigned
Mar 5, 2019
Last updated
Mar 5, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2019

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

Authorized official

Name
Dr. Peter William Vercellino, DCNPI 1619434388
Title
Chiropractor
Phone
(217) 520-4433

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU Primary

Addresses

Primary practice location

3350 N Water St Ste a
Decatur, IL 62526-2353

Mailing address

3350 N Water St Ste a
Decatur, IL 62526-2353
Phone (217) 877-2404

Other names 1

  • Decatur Back and Neck Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190405001577 IL Part B Supplier - Clinic/Group Practice 4284975970 Receives reassigned benefits from 1 practitioner
Practice locations: Decatur, IL

National Provider Directory

National Provider Directory

Locations

3350 N Water St
Ste A
Decatur, IL 62526
Phone (217) 520-4433

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1551744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551744000000",
    "number": "1881152288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 N WATER ST STE A",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625262353",
            "telephone_number": "217-877-2404",
            "fax_number": "217-877-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 N WATER ST STE A",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625262353",
            "telephone_number": "217-877-2404",
            "fax_number": "217-877-2522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VERCELLINO PURCHASING CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-05",
        "last_updated": "2019-03-05",
        "status": "A",
        "authorized_official_last_name": "VERCELLINO",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "217-520-4433",
        "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": [
        {
            "organization_name": "Decatur Back and Neck Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Decatur, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2019; 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.