Individual provider Active NPI

Terry Glen Smith, D.C.

  • Chiropractor
  • East Moline, IL
National Provider Identifier
1962544726
Registry record updated Mar 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-006661 Issued in IL
Practice address
379 Avenue of the Cities
East Moline, IL 61244-4023
Phone
(309) 752-1410
NPI assigned
Feb 12, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 2, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038-006661 IL Primary

Addresses

Primary practice location

379 Avenue of the Cities
East Moline, IL 61244-4023

Mailing address

379 Avenue of the Cities
East Moline, IL 61244-4023
Phone (309) 752-1410

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050314000593 IL Practitioner - Chiropractic 1951356831 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1989
Medicare assignment
May accept Medicare assignment
Group practices
Heartland Chiropractic Clinic PLLCGroup PAC ID 3375950041, 2 clinicians

Practice addresses (Care Compare)

4500 Kennedy Dr
East Moline, IL 61244-4268
Phone (309) 752-1410

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038-006661ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Heartland Chiropractic Clinic, PLLC CurrentSince Jan 1, 2021 Accepting new patients

Locations

379 Avenue of the Cities
East Moline, IL 61244
Phone (309) 752-1410

4500 Kennedy Dr
East Moline, IL 61244
Phone (309) 752-1410

Organizations & group practices 1

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": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425254400000",
    "number": "1962544726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "379 AVENUE OF THE CITIES",
            "city": "EAST MOLINE",
            "state": "IL",
            "postal_code": "612444023",
            "telephone_number": "309-752-1410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "379 AVENUE OF THE CITIES",
            "city": "EAST MOLINE",
            "state": "IL",
            "postal_code": "612444023",
            "telephone_number": "309-752-1410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "TERRY",
        "middle_name": "GLEN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2015-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-006661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Moline, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2015; 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.