SOUTHPORT GRACE CHIROPRACTIC AND WELLNESS LLC
NPI 1629539291
Chiropractor in Chicago, IL

Q: What is Southport Grace Chiropractic And Wellness LLC's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Active since March 27, 2019

1209 W GRACE ST, CHICAGO, IL 60613(772) 525-2225 Get Directions Write a Review

NPPES record last updated: May 8, 2019. Verified against the NPPES registry weekly; last sync: November 01, 2026.

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About Southport Grace Chiropractic And Wellness Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHPORT GRACE CHIROPRACTIC AND WELLNESS LLC (NPI 1629539291) is a healthcare organization registered as a chiropractor in Chicago, Illinois and active in the NPI registry since March 2019. The organization lists Keith Olding, Chiropractor, as its authorized official.

NPPES Registry Identity

NPI1629539291

Entity TypeOrganization

Primary Taxonomy111N00000X

Legal Business NameSOUTHPORT GRACE CHIROPRACTIC AND WELLNESS LLC

Location Address1209 W GRACE STChicago, IL 60613-2805

Mailing Address1209 W Grace St Ste 1Chicago, IL 60613-2805 · (772) 525-2225

Phone(772) 525-2225

Organization SubpartNo

Authorized OfficialKeith OldingChiropractor · (419) 628-4003

Enumeration DateMarch 27, 2019

Last NPPES UpdateMay 8, 2019

✔ NPI 1629539291 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyChiropractorChiropractic Providers

Taxonomy Code111N00000X

Definition

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.

1209 W GRACE ST, Chicago, IL 60613

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Southport Grace Chiropractic And Wellness Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Southport Grace Chiropractic And Wellness LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Keith Olding, D.C.

Chiropractic

NPI 1881786424

1209 W GRACE ST
Chicago, IL 60613

(773) 525-2225

Same address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southport Grace Chiropractic And Wellness LLC's NPI number?

The NPI number for Southport Grace Chiropractic And Wellness LLC is 1629539291. It was assigned to this organization in the NPPES registry on March 27, 2019.

Where is Southport Grace Chiropractic And Wellness LLC located?

Southport Grace Chiropractic And Wellness LLC is located at 1209 W Grace St, Chicago, IL 60613. The listed phone number is (772) 525-2225.

What is Southport Grace Chiropractic And Wellness LLC's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Is Southport Grace Chiropractic And Wellness LLC enrolled in Medicare?

Yes. Southport Grace Chiropractic And Wellness LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southport Grace Chiropractic And Wellness LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Chiropractic) reassigns their Medicare billing to Southport Grace Chiropractic And Wellness LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Southport Grace Chiropractic And Wellness LLC was last updated on May 8, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.