Verified record
Source: Illinois IDFPR license registry + NPPES. High trust.
Profession
Chiropractic Physician · DC
IL license
038008186 — ACTIVE
Disciplinary record
On record — see detail below
NPI
1265558837 · matched by license
Practice city
South Beloit
Pediatric
provider has not provided attestation
IDFPR disciplinary record · 6 actions on record
The Illinois Dept. of Financial & Professional Regulation (IDFPR) maintains a public record of disciplinary actions on professional licenses. The detail below is reproduced verbatim from the IDFPR licensing dataset — it is not a characterization by PedsList.
ProbationOct 27, 2020· IDFPR case 2017007971
chiropractic physician license suspended for 60 days; thereafter placed on probation with CME for six months after allegedly respondent failed to report to the Department that his Medicare enrollment and billing privileges were revoked by the Centers for Medicare and Medicaid Services effective 07/30/2018, in violation of the January 2018 Consent Order.
SuspensionAug 27, 2020· IDFPR case 2017007971
chiropractic physician license suspended for 60 days; thereafter placed on probation with CME for six months after allegedly respondent failed to report to the Department that his Medicare enrollment and billing privileges were revoked by the Centers for Medicare and Medicaid Services effective 07/30/2018, in violation of the January 2018 Consent Order.
SuspensionAug 27, 2020· IDFPR case 2017007971
chiropractor license automatically, indefinitely suspended for a minimum of 12 months for violation of the Department's Probation.
ProbationApr 18, 2018· IDFPR case 2017007971
for disclosing 1998 conviction for mail fraud in Missouri on his 2017 renewal license application.
SuspensionFeb 16, 2018· IDFPR case 2017007971
for disclosing 1998 conviction for mail fraud in Missouri on his 2017 renewal license application.
FineJan 26, 2018· IDFPR case 2017007971
for disclosing 1998 conviction for mail fraud in Missouri on his 2017 renewal license application.
Source: IDFPR license lookup · dataset data.illinois.gov / pzzh-kp68. Some actions are administrative (e.g. continuing-education or renewal lapses) and don't indicate patient harm; where wording reads "allegedly," it reflects allegations as recorded by IDFPR, not by itself a current finding of wrongdoing.
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