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Organization
SAMPLE CHIROPRACTIC, LTD.
Active
Organization
SAMPLE CHIROPRACTIC, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAWN M SAMPLE DC (OWNER)
(815) 468-7787
Entity
Organization
Contact information
Practice address
51 N MAIN ST, MANTENO, IL 60950-1534
(815) 468-7787
(815) 468-0154
Mailing address
51 N MAIN ST, MANTENO, IL 60950-1534
(815) 468-7787
(815) 468-0154
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CI3079
RR MED GROUP NUMBER
IL
Enumeration date
10/04/2006
Last updated
04/02/2008
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