Individual
DR. MATTHEW RAY CHENAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D. C.
Contact information
Practice address
1105 E HARRIS AVE, GREENVILLE, IL 62246-2221
(618) 664-4600
Mailing address
4016 VESCI AVE, GRANITE CITY, IL 62040-2925
(618) 659-1699
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038-009435
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0332010
BCBS
IL
05
—
038009435
—
IL
01
—
109433
GHP
IL
01
—
412192761
TAX ID
IL
01
—
466637
HEALTHLINK
IL
01
—
51316
CIGNA
IL
01
—
DE3519
RR MEDICARE GROUP
IL
01
—
P00287309
RR MEDICARE
IL
Enumeration date
10/16/2006
Last updated
06/05/2008
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