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Organization
PERFORMANCE CHIROPRACTIC OF SOUTHERN ILLINOIS LLC
Active
Organization
PERFORMANCE CHIROPRACTIC OF SOUTHERN ILLINOIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN AUGUST GULLETT DC (OWNER)
(618) 997-3257
Entity
Organization
Contact information
Practice address
3905 W ERNESTINE DR, SUITE B, MARION, IL 62959-5800
(618) 997-3257
Mailing address
3905 W ERNESTINE DR, SUITE B, MARION, IL 62959-5800
(618) 997-3257
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038011259
IL
Other
Enumeration date
11/19/2008
Last updated
11/19/2008
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