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Organization
PAIN RELIEF CENTER OF VANDALIA INC
Active
Organization
PAIN RELIEF CENTER OF VANDALIA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY RYAN CLARK DC (DOCTOR OF CHIROPRACTIC)
(618) 283-1100
Entity
Organization
Contact information
Practice address
100 N KENNEDY BLVD, VANDALIA, IL 62471
(618) 283-1100
(618) 283-1101
Mailing address
100 N KENNEDY BLVD, VANDALIA, IL 62471
(618) 283-1100
(618) 283-1101
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038009768
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02632010
BCBS
IL
01
—
539980
HL
IL
Enumeration date
08/29/2006
Last updated
06/19/2015
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