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Organization
SOUTHERN ILLINOIS SPORT AND SPINE LLC
Active
Organization
SOUTHERN ILLINOIS SPORT AND SPINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUKE WILLIAM KOEHN D.C. (CHIROPRACTOR)
(618) 521-0552
Entity
Organization
Contact information
Practice address
106 W WASHINGTON ST, BENTON, IL 62812-1337
(618) 435-3888
Mailing address
106 W WASHINGTON ST, BENTON, IL 62812-1337
(618) 435-3888
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038012350
IL
Other
Enumeration date
02/17/2013
Last updated
05/07/2013
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