Individual provider Active NPI

Brent Wayne Adams, DC

  • Chiropractor
  • Bradley, IL
National Provider Identifier
1992854251
Registry record updated Jul 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038010846 Issued in IL
Practice address
535 E North St Ste a
Bradley, IL 60915-1188
Phone
(815) 614-3073
Fax
(815) 286-4790
NPI assigned
Jan 9, 2007
Last updated
Jul 6, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038010846 IL Primary

Addresses

Primary practice location

535 E North St Ste a
Bradley, IL 60915-1188

Mailing address

535 E North St Ste a
Bradley, IL 60915-1188
Phone (815) 614-3073

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070209000035 IL Practitioner - Chiropractic 5092717793 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038010846ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Chiropractic Associates of Kankakee Inc CurrentSince Mar 27, 2009 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Sample Chiropractic, LTD. Chiropractor PastSince May 1, 2008 Accepting new patients

Locations

232 N Industrial Dr
Bradley, IL 60915
Phone (815) 614-3073

535 E North St
Ste A
Bradley, IL 60915
Phone (815) 614-3073

53 N Main St
Manteno, IL 60950
Phone (815) 468-7787

Organizations & group practices 3

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": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657065600000",
    "number": "1992854251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 E NORTH ST STE A",
            "city": "BRADLEY",
            "state": "IL",
            "postal_code": "609151188",
            "telephone_number": "815-614-3073",
            "fax_number": "815-286-4790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 E NORTH ST STE A",
            "city": "BRADLEY",
            "state": "IL",
            "postal_code": "609151188",
            "telephone_number": "815-614-3073",
            "fax_number": "815-286-4790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADAMS",
        "first_name": "BRENT",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2022-07-06",
        "certification_date": "2022-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038010846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradley, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.