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Organization
GHOLSON CHIROPRACTIC LIFE & HEALTH LTD
Active
Organization
GHOLSON CHIROPRACTIC LIFE & HEALTH LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRAVIS RHINE GHOLSON DC (DOCTOR OF CHIROPRACTIC)
(618) 384-2631
Entity
Organization
Contact information
Practice address
1624 W MAIN ST, CARMI, IL 62821-2235
(618) 384-3621
(618) 384-2908
Mailing address
1624 W MAIN ST, CARMI, IL 62821-2235
(618) 384-2631
(618) 384-2908
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038008660
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038008660
—
IL
01
—
09726159
BLUE CROSS SHIELD IL
IL
Enumeration date
09/20/2006
Last updated
08/19/2009
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