Active NPI
John Marvin Everingham, D.C.
- Chiropractor
- Normal, IL
National Provider Identifier
1972687457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 038-005103
- Practice address
- 1603 Visa Dr
Normal, IL 61761-2131 - Phone
- (309) 268-9000
- Fax
- (309) 268-9003
- NPI assigned
- Oct 24, 2006
- Last updated
- May 19, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038-005103 | IL | Primary |
Addresses
Primary practice location
1603 Visa Dr
Normal, IL 61761-2131
Mailing address
1603 Visa Dr
Normal, IL 61761-2131
Phone (309) 268-9000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5715397 | Other | IL | BCBS OF ILLINOIS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- National College of Chiropractic, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1603 Visa Dr
Normal, IL 61761-2131
Phone (309) 268-9000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038-005103 | IL | MD | Chiropractor |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589846400000",
"number": "1972687457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1603 VISA DR",
"city": "NORMAL",
"state": "IL",
"postal_code": "617612131",
"telephone_number": "309-268-9000",
"fax_number": "309-268-9003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1603 VISA DR",
"city": "NORMAL",
"state": "IL",
"postal_code": "617612131",
"telephone_number": "309-268-9000",
"fax_number": "309-268-9003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVERINGHAM",
"first_name": "JOHN",
"middle_name": "MARVIN",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2020-05-19",
"certification_date": "2020-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IL",
"license": "038-005103",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF ILLINOIS",
"identifier": "5715397",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Normal, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2020; 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.