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SOUTHERN ILLINOIS CHIROPRACTIC CENTER NPI 1407991771


NPI Information

NPI: 1407991771
Provider Name: SOUTHERN ILLINOIS CHIROPRACTIC CENTER
Classification: Chiropractor - 111N00000X
Entity Type: Organization
Address:
2 PROFESSIONAL PARK DRIVE
SUITE B
MARYVILLE, IL
ZIP 62062
Phone: (618) 288-7991
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SOUTHERN ILLINOIS CHIROPRACTIC CENTER is a chiropractor in Maryville, IL. The provider is 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. SOUTHERN ILLINOIS CHIROPRACTIC CENTER NPI is 1407991771. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2 PROFESSIONAL PARK DRIVE
SUITE B
MARYVILLE, IL
ZIP 62062-746
Phone: (618) 288-7991
Fax: (618) 288-7901

The provider's authorized official is Barry T Delassus .
The authorized official title is Owner Chiropractor and has the following contact phone number (618) 288-7991.

The enumeration date for this NPI number is 2/21/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1111N00000XChiropractorILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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