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Organization

SOUTHERN ILLINOIS MEDICAL PLAZA SC

Active
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Organization

SOUTHERN ILLINOIS MEDICAL PLAZA SC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. STEVEN PATRICK BARRETT D.C. (PRESIDENT)
(618) 529-1943
Entity
Organization

Contact information

Practice address
2250 REED STATION PKWY, STE 305, CARBONDALE, IL 62901-3304
(618) 529-1943
(618) 549-2975
Mailing address
2250 REED STATION PKWY, CARBONDALE, IL 62901
(618) 529-1943
(618) 549-2975

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038007699
IL
207Q00000X
Family Medicine Physician
036093859
IL
225100000X
Physical Therapist
—
—
225700000X
Massage Therapist
—
—

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03932090
BCBS OF IL GROUP
IL
Enumeration date
12/17/2007
Last updated
09/21/2010
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