NPIMap

Organization Active NPI

Southpark Chiropractic Wellness Center, LLC

  • Primary Care Clinic/Center
  • Moline, IL
National Provider Identifier
1972893121
Registry record updated Apr 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
038011683 Issued in IL
Legal business name
SOUTHPARK CHIROPRACTIC WELLNESS CENTER, LLC
Practice address
1529 46TH Ave
Suite 4
Moline, IL 61265-7084
Phone
(309) 757-7100
Fax
(309) 757-7111
NPI assigned
Apr 8, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2011

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

Authorized official

Name
Lee Fixen, D.C.
Title
Owner
Phone
(309) 757-7100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 038011683 IL Primary

Addresses

Primary practice location

1529 46TH Ave
Suite 4
Moline, IL 61265-7084

Mailing address

1529 46TH Ave
Suite 4
Moline, IL 61265-7084
Phone (309) 757-7100

National Provider Directory

National Provider Directory

Locations

1529 46th Ave
Ste 4
Moline, IL 61265
Phone (309) 757-7100

Practitioners & affiliated clinicians

Practitioners 1

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": "1302220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302220800000",
    "number": "1972893121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1529 46TH AVE",
            "address_2": "SUITE 4",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657084",
            "telephone_number": "309-757-7100",
            "fax_number": "309-757-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1529 46TH AVE",
            "address_2": "SUITE 4",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657084",
            "telephone_number": "309-757-7100",
            "fax_number": "309-757-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPARK CHIROPRACTIC WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-08",
        "last_updated": "2011-04-08",
        "status": "A",
        "authorized_official_last_name": "FIXEN",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-757-7100",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "038011683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moline, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.