DR. SITSADAPHONE PHETCHAMPHONE (NPI# 1780739284) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780739284 |
| Entity Type | Individual |
| Full Name | DR. SITSADAPHONE PHETCHAMPHONE |
| Credential | DC |
| Practice Address |
1157 W 18th St Chicago IL 60608 |
| Mailing Address |
1157 W 18th St Chicago IL 60608-2387 |
| Practice Telephone | 3123441632 |
| Mailing Telephone | 3123441632 |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2019-02-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 111N00000X | Chiropractor | 038010281 | IL | Chiropractic Providers |
| Y | 111N00000X | Chiropractor | 038-010281 | IL | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS BLUE SHIELD | 2232625 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 504 Legacy Plz W, La Porte, La Porte, IN 463505254 | 2193267246 |
| Street Address |
1157 W 18TH ST |
| City | CHICAGO |
| State | IL |
| Zip Code | 60608 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942389663 | Phoxay Phetthongsy | Chiropractor | 1157 W 18th St, Chicago, IL 60608-2387 | 2006-11-03 |
| 1982197158 | Hol Health Studio LLC | Clinic/Center | 1157 W 18th St, Chicago, IL 60608-2387 | 2018-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699390047 | Bethuna Shields | Occupational Therapist | 1401 South California Ave, Chicago, IL 60608 | 2020-06-11 |
| 1861024176 | Mount Sinai Community Foundation | Clinic/Center | 1414 S Fairfield, Chicago, IL 60608 | 2020-02-05 |
| 1205481058 | Joshua Hartman | Pharmacist | 345 Csb Mc 884, 840 S. Wood St, Chicago, IL 60608 | 2019-08-08 |
| 1194386706 | Mount Sinai Hospital, Chicago | Internal Medicine | Mount Sinai Hospital, 1500 S Fairfield Ave, Chicago, IL 60608 | 2019-06-25 |
| 1841754256 | Julia Bates | Occupational Therapist | 1640 W. Roosevelt Rd., 415 Dhsp (mc 726), Chicago, IL 60608 | 2019-01-30 |
| 1194205781 | Anais J Robles | Contractor | 1626 S Allport St, Chicago, IL 60608 | 2018-08-14 |
| 1114412970 | Dmitri Zbarsky | Internal Medicine | 1500 South Fairfield Ave., F-914, Chicago, IL 60608 | 2018-06-25 |
| 1740773050 | Alexia Ilian Derma Salazar | Speech-Language Pathologist | 2301 W 19th St - 3rd Floor Rear, Chicago, IL 60608 | 2018-06-11 |
| 1912424730 | Pareen Modi | Pharmacist | 2539 South Western Avenue, Chicago, IL 60608 | 2017-08-23 |
| 1952824302 | Raquel Gonzalez Heredia | Surgery | 1500 South Fairfield Ave, Chicago, IL 60608 | 2017-07-18 |
| Find all providers in zip 60608 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881208080 | Christian James Koch | Chiropractor | 5100 N Ravenswood Ave Ste 107, Chicago, IL 60640-1710 | 2020-09-04 |
| 1164035879 | Scott Spine and Health LLC | Chiropractor | 2560 W. Armitage Ave, Unit C2, Chicago, IL 60647 | 2020-08-24 |
| 1104448547 | Katie Niebur | Chiropractor | 6909 W Medill Ave, Chicago, IL 60707-2910 | 2020-05-07 |
| 1063031003 | Bazan's Health Center Inc | Chiropractor | 4012 W 63rd St, Chicago, IL 60629-4606 | 2020-04-09 |
| 1346875861 | Christopher A Haslett Dc P.c | Chiropractor | 400 N Wells St Ste 300, Chicago, IL 60654-2761 | 2020-03-04 |
| 1245870138 | Be Well Chiropractic Clinics LLC | Chiropractor | 3648 W Montrose Ave Apt 2e, Chicago, IL 60618-1979 | 2020-01-08 |
| 1982242186 | Michael Tal Risher | Chiropractor | 2378 N Elston Ct, Chicago, IL 60614-2929 | 2019-12-18 |
| 1821632423 | Rachel Nicole Leibovitz | Chiropractor | 624 W Belmont Ave, Chicago, IL 60657-4511 | 2019-11-06 |
| 1053954180 | Aaron Alexander Bryant | Chiropractor | 125 N Halsted St Ste 202, Chicago, IL 60661-2160 | 2019-10-22 |
| 1073156238 | Omar A. Bleibel | Chiropractor | 4801 W Peterson Ave Ste 505, Chicago, IL 60646-5795 | 2019-10-21 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.