SOUTHERN ILLINOIS SPINE & JOINT CENTER (NPI# 1790090579) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790090579 |
| Entity Type | Organization |
| Organization Name | SOUTHERN ILLINOIS SPINE & JOINT CENTER |
| Practice Address |
112 N Main St Marissa IL 62257-1365 |
| Practice Telephone | 6182952268 |
| Mailing Telephone | 6182952268 |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2010-08-17 |
| Authorized Official Name | DR. RYAN ROBERT REISS (MEMBER) |
| Authorized Official Telephone | 6184432026 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 038003579 | IL | Chiropractic Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SOUTHERN ILLINOIS SPINE & JOINT CENTER LLC | 202 W Jackson St Ste A, Sparta, IL 62286-1676 |
| Street Address |
112 N MAIN ST |
| City | MARISSA |
| State | IL |
| Zip Code | 62257-1365 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053664557 | Southern Illinois Spine & Joint Center of Marissa LLC | Chiropractor | 112 N Main St, Marissa, IL 62257-1365 | 2012-10-22 |
| 1821392952 | Dillon Lee Kaesberg | Chiropractor | 112 N Main St, Marissa, IL 62257-1365 | 2011-01-04 |
| 1235261066 | Gary Lane Benedict | Chiropractor | 112 N Main St, Marissa, IL 62257-1342 | 2007-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952782971 | Megan Schmersahl | Physical Therapy Assistant | 249 Darmstadt Rd., Marissa, IL 62257 | 2015-06-16 |
| 1003980111 | Marissa Food Mart | Pharmacy | 700 E. Lyons St., Marissa, IL 62257 | 2006-11-20 |
| 1922114800 | Sparta Community Hospital D/b/a Quality Healthcare Clinics | Clinic/Center | 521 C North Borders, Marissa Medical Clinic, Marissa, IL 62257 | 2006-08-22 |
| 1033264791 | Southern Illinois Eye Care, PC | Optometrist | 521 N Borders Ave, Marissa, IL 62257-1117 | 2007-01-24 |
| 1831181288 | Delbert Arthur Bollmann | Pharmacist | 700 E Lyons St, Marissa, IL 62257-1141 | 2005-08-19 |
| 1053518597 | Steven Earl Dorf | Dentist | 607 E Lyons St, Marissa, IL 62257-1159 | 2007-06-28 |
| 1619193869 | Kelly Ann Wood | Family Medicine | 521 N Borders Ave Ste C, Marissa Medical Clinic, Marissa, IL 62257-1195 | 2007-04-17 |
| 1396218202 | Jennifer Adele Demsar | Nurse Practitioner | 521 N Borders Ave Ste C, Marissa, IL 62257-1195 | 2019-01-03 |
| 1497728430 | Kevin R Behn | Dentist | 115 N Main St, Marissa, IL 62257-1341 | 2006-02-09 |
| 1700068012 | Shaw Pharmacy | Pharmacy | 219 N Main St, Marissa, IL 62257-1343 | 2007-11-28 |
| Find all providers in zip 62257 | ||||
| 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 |
|---|---|---|---|---|
| 1053664557 | Southern Illinois Spine & Joint Center of Marissa LLC | Chiropractor | 112 N Main St, Marissa, IL 62257-1365 | 2012-10-22 |
| 1821392952 | Dillon Lee Kaesberg | Chiropractor | 112 N Main St, Marissa, IL 62257-1365 | 2011-01-04 |
| 1235261066 | Gary Lane Benedict | Chiropractor | 112 N Main St, Marissa, IL 62257-1342 | 2007-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548861347 | Evan Charles Mojica | Chiropractor | 1803 W State St Ste 150, Geneva, IL 60134-3692 | 2020-11-06 |
| 1407454424 | Mikel Marshall | Chiropractor | 881 S Lorraine Rd Apt 103, Wheaton, IL 60189-6924 | 2020-10-12 |
| 1912505157 | David Anthony Wesdock | Chiropractor | 208 Parkinson St, Normal, IL 61761-3079 | 2020-10-10 |
| 1902403124 | Maranda Joe Humphreys | Chiropractor | 2150 Manchester Rd Ste 100, Wheaton, IL 60187-2474 | 2020-10-01 |
| 1023625654 | Kennedy Nicole Brauer | Chiropractor | 208 Flax Dr Ste 200, Highland, IL 62249-1394 | 2020-09-28 |
| 1649886730 | Simply Wellness Chiropractic, LLC | Chiropractor | 7117 Crimson Ridge Dr Ste 1, Rockford, IL 61107-6213 | 2020-09-23 |
| 1639785330 | Eve Marie Greenwell | Chiropractor | 143 N Henderson St, Mt Zion, IL 62549-1313 | 2020-09-17 |
| 1588279640 | Guadalupe Garcia | Chiropractor | 2745 Maple Ave Ste 2d, Lisle, IL 60532-3231 | 2020-09-14 |
| 1770197774 | Align Services Bloomington Pllc | Chiropractor | 2309 E Empire St Ste 200a, Bloomington, IL 61704-8636 | 2020-09-07 |
| 1881208080 | Christian James Koch | Chiropractor | 5100 N Ravenswood Ave Ste 107, Chicago, IL 60640-1710 | 2020-09-04 |
| Find all providers with the same taxonomy | ||||
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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.