Jodi Beth Buskohl Southern Il Chiropractic Clinic

Key facts

NPI: 1982816625
Entity type: Organization (NPI type 2)
Primary specialty: Chiropractor 111N00000X
Legal business name: JODI BETH BUSKOHL SOUTHERN IL CHIROPRACTIC CLINIC
Practice address: 2447 State St.
Chester, IL 62233
Phone: (618) 826-5475
NPI assigned: May 4, 2007
Organization subpart: No

Authorized official

Name: Dr. Jodi Buskohl, DC
Title: Chiropractor
Phone: (618) 826-5475

Practitioners 1

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

Jodi Beth Buskohl, D.C. Chiropractor · Chester, IL · NPI 1649261736

Medicare reassignment NPD CHIROPRACTOR · IL

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
14D2235456	Southern Il Chiropractic 2447 State St, Chester, IL 62233	Certificate of waiver	Sep 8, 2027

Medicare participation

Medicare fee-for-service enrollment: Enrolled in IL

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20070926000723	IL	Part B Supplier - Clinic/Group Practice	5890889455	Receives reassigned benefits from 1 practitioner Practice locations: Chester, IL

National Provider Directory

Locations

2447 State St
Chester, IL 62233
Phone (618) 826-5475

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Chiropractor Group: 193400000X SINGLE SPECIALTY GROUP	111N00000X		IL	Yes

Addresses

Primary practice location

2447 State St.
Chester, IL 62233

Mailing address

2447 State St.
Chester, IL 62233

Other providers in Chester, IL

All providers in Chester, IL · Chiropractor in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2008. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (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.