Organization
STATELINE CHIROPRACTIC & SPORTS INJURY CLINIC SC
Active
Organization
STATELINE CHIROPRACTIC & SPORTS INJURY CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH PROBST DC (PRESIDENT)
(815) 389-7870
Entity
Organization
Contact information
Practice address
1407 PATE PLAZA DR, SOUTH BELOIT, IL 61080
(815) 389-7870
Mailing address
1407 PATE PLAZA DR, SOUTH BELOIT, IL 61080-1431
(815) 389-7870
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
038008186
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
038008186
LIC NUMBER
IL
Enumeration date
05/03/2007
Last updated
08/01/2018
Update your record
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