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PAIN RELIEF CENTER OF VANDALIA INC NPI 1588773089


NPI Information

NPI: 1588773089
Provider Name: PAIN RELIEF CENTER OF VANDALIA INC
Classification: Chiropractor - 111N00000X
Entity Type: Organization
Address:
100 N KENNEDY BLVD
VANDALIA, IL
ZIP 62471
Phone: (618) 283-1100
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PAIN RELIEF CENTER OF VANDALIA INC is a chiropractor in Vandalia, 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. PAIN RELIEF CENTER OF VANDALIA INC NPI is 1588773089. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

100 N KENNEDY BLVD
VANDALIA, IL
ZIP 62471
Phone: (618) 283-1100
Fax: (618) 283-1101

The provider's authorized official is Jeremy Ryan Clark .
The authorized official title is Doctor Of Chiropractic and has the following contact phone number (618) 283-1100.

The enumeration date for this NPI number is 8/29/2006 and was last updated on 6/19/2015.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1111N00000XChiropractor038009768ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
102632010OTHERILLINOISBCBS
2539980OTHERILLINOISHL
3211990MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
4U94085MEDICARE UPIN

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: 11/14/2023

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