Kory Stassi, D.C.
Individual provider Active NPI Chiropractor · Bethalto, IL
NPI 1891151858 · NPPES record last updated Dec 15, 2016
Key facts
- NPI
- 1891151858
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038012925 (IL)
- Practice address
- 112 W Bethalto Blvd
Bethalto, IL 62010-1703 - Phone
- (618) 304-6360
- NPI assigned
- Jan 6, 2016
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Logan College of Chiropractic, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Stassi Chiropractic and Wellness Center LLC
Practice addresses (Care Compare)
112 W Bethalto Blvd
Bethalto, IL 62010-1703
Phone (618) 717-0621
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160321002042 | IL | Practitioner - Chiropractic | 4981901824 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038012925 | IL | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stassi Chiropractic & Wellness Center LLC | Chiropractor | Current |
Accepting new patients |
Locations
112 W Bethalto Blvd
Bethalto, IL 62010
Phone (618) 304-6360
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038012925 | IL | Yes |
Addresses
Primary practice location
112 W Bethalto Blvd
Bethalto, IL 62010-1703
Mailing address
112 W Bethalto Blvd
Bethalto, IL 62010-1703
Phone (618) 304-6360
Other providers in Bethalto, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.