NPIMap

Organization Active NPI

Progressive Spine & Joint Center LLC

  • Chiropractor
  • O Fallon, IL
National Provider Identifier
1902117237
Registry record updated Feb 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038011632 Issued in IL
Legal business name
PROGRESSIVE SPINE & JOINT CENTER LLC
Practice address
4965 Stone Falls Ctr
Suite 3
O Fallon, IL 62269-7803
Phone
(618) 622-0096
Fax
(618) 624-9386
NPI assigned
Jul 1, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2011

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

Authorized official

Name
Dr. Jordan Wade Vickery, D.C.
Title
Chiropractor/Owner
Phone
(618) 622-0096

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 038011632 IL Primary

Addresses

Primary practice location

4965 Stone Falls Ctr
Suite 3
O Fallon, IL 62269-7803

Mailing address

4965 Stone Falls Ctr
Suite 3
O Fallon, IL 62269-7803
Phone (618) 622-0096

National Provider Directory

National Provider Directory

Locations

4965 Stone Falls Ctr
Ste 3
O Fallon, IL 62269
Phone (618) 622-0096

NPI Registry JSON

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

{
    "created_epoch": "1277942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297814400000",
    "number": "1902117237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4965 STONE FALLS CTR",
            "address_2": "SUITE 3",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697803",
            "telephone_number": "618-622-0096",
            "fax_number": "618-624-9386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4965 STONE FALLS CTR",
            "address_2": "SUITE 3",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622697803",
            "telephone_number": "618-622-0096",
            "fax_number": "618-624-9386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE SPINE & JOINT CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-01",
        "last_updated": "2011-02-16",
        "status": "A",
        "authorized_official_last_name": "VICKERY",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "CHIROPRACTOR/OWNER",
        "authorized_official_telephone_number": "618-622-0096",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038011632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2011; 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.