Individual provider Active NPI

John Thomas Reynolds, D.C.

  • Chiropractor
  • Freeport, IL
National Provider Identifier
1922094119
Registry record updated Nov 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038009341 Issued in IL
Practice address
630 Terra West Dr
Freeport, IL 61032-4536
Phone
(815) 235-7858
Fax
(815) 235-7913
NPI assigned
Sep 22, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 27, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038009341 IL Primary

Addresses

Primary practice location

630 Terra West Dr
Freeport, IL 61032-4536

Mailing address

630 Terra West Dr
Freeport, IL 61032-4536
Phone (815) 235-7858

Other identifiers 5

IdentifierTypeStateIssuer
5979340OtherILCIGNA
004932381OtherILBC/BS
2017038OtherILFIRST HEALTH
7531336OtherILAETNA - PPO
3474535OtherILAETNA - HMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090310000411 IL Practitioner - Chiropractic 5294891677 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hulsebus and Gehlsen ChiropracticGroup PAC ID 1557324415, 2 clinicians

Practice addresses (Care Compare)

630 Terra W Dr
Freeport, IL 61032-4536
Phone (815) 235-7858

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038009341ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Hulsebus and Gehlsen Chiropractic Chiropractor CurrentSince Dec 3, 2012 Accepting new patients
Strelcheck Chiropractic Clinic LTD Chiropractor PastSince Dec 29, 2005 Accepting new patients

Locations

630 Terra West Dr
Freeport, IL 61032
Phone (815) 235-7858

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353974400000",
    "number": "1922094119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 TERRA WEST DR",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610324536",
            "telephone_number": "815-235-7858",
            "fax_number": "815-235-7913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 TERRA WEST DR",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610324536",
            "telephone_number": "815-235-7858",
            "fax_number": "815-235-7913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "JOHN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-22",
        "last_updated": "2012-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038009341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5979340",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "004932381",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "2017038",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA - PPO",
            "identifier": "7531336",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA - HMO",
            "identifier": "3474535",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Freeport, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.