NPIMap

Organization Active NPI

Mount Vernon Chiropractic Clinic

  • Clinic/Center
  • Mount Vernon, IL
National Provider Identifier
1881888105
Registry record updated Aug 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
038006100 Issued in IL
Legal business name
MOUNT VERNON CHIROPRACTIC CLINIC
Practice address
1315 Main St
Mount Vernon, IL 62864-3720
Phone
(618) 242-4554
Fax
(618) 242-4653
NPI assigned
Aug 29, 2007
Last updated
Aug 29, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2007

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

Authorized official

Name
Dr. Bradley Ray Drake, D.C.NPI 1144330945
Title
Chiropractor
Phone
(618) 242-4554

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
Clinic/Center 261Q00000X 038006100 IL Primary

Addresses

Primary practice location

1315 Main St
Mount Vernon, IL 62864-3720

Mailing address

1315 Main St
Mount Vernon, IL 62864-3720
Phone (618) 242-4554

Other identifiers 3

IdentifierTypeStateIssuer
350027546OtherILPALMETTO RR MEDICARE
4182010OtherILBLUE CROSS BLUE SHIELD
038006100MedicaidIL

National Provider Directory

National Provider Directory

Locations

1315 Main St
Mount Vernon, IL 62864
Phone (618) 242-4554

Practitioners & affiliated clinicians

Practitioners 1

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": "1188345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188345600000",
    "number": "1881888105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 MAIN ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628643720",
            "telephone_number": "618-242-4554",
            "fax_number": "618-242-4653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 MAIN ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628643720",
            "telephone_number": "618-242-4554",
            "fax_number": "618-242-4653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT VERNON CHIROPRACTIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-29",
        "last_updated": "2007-08-29",
        "status": "A",
        "authorized_official_last_name": "DRAKE",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "618-242-4554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "038006100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO RR MEDICARE",
            "identifier": "350027546",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4182010",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038006100",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2007; 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.