NPIMap

Organization Active NPI

Wellnessone of East Belleville, LLC

  • Chiropractor
  • Belleville, IL
National Provider Identifier
1912125485
Registry record updated Oct 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
WELLNESSONE OF EAST BELLEVILLE, LLC
Practice address
1634 Carlyle Ave
Belleville, IL 62221-4558
Phone
(618) 235-0777
Fax
(618) 235-9440
NPI assigned
Apr 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2007

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

Authorized official

Name
Scott M Dorrity, D.C.NPI 1407895824
Title
Managing Employee
Phone
(618) 398-9716

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X IL Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X IL

Addresses

Primary practice location

1634 Carlyle Ave
Belleville, IL 62221-4558

Mailing address

1634 Carlyle Ave
Belleville, IL 62221-4558
Phone (618) 235-0777

Other identifiers 1

IdentifierTypeStateIssuer
08212176OtherILBCBS GROUP NUMBER

National Provider Directory

National Provider Directory

Locations

1634 Carlyle Ave
Belleville, IL 62221
Phone (618) 234-0777

2600 West Blvd
Belleville, IL 62221
Phone (618) 235-0777

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192060800000",
    "number": "1912125485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1634 CARLYLE AVE",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622214558",
            "telephone_number": "618-235-0777",
            "fax_number": "618-235-9440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1634 CARLYLE AVE",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622214558",
            "telephone_number": "618-235-0777",
            "fax_number": "618-235-9440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESSONE OF EAST BELLEVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2007-10-11",
        "status": "A",
        "authorized_official_last_name": "DORRITY",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGING EMPLOYEE",
        "authorized_official_telephone_number": "618-398-9716",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "08212176",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.