Organization
CHIROM-MED LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN ELAINE IVY B.A. (OFFICE MANAGER)
(618) 235-3200
Entity
Organization
Contact information
Practice address
3200 W MAIN ST, BELLEVILLE, IL 62226-6620
(618) 235-3200
(618) 235-3282
Mailing address
3200 W MAIN ST, BELLEVILLE, IL 62226-6620
(618) 235-3200
(618) 235-3282
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
142955
COVENTRY ID#
IL
01
—
40000221
UHC ID#
IL
01
—
400198
HELATHLINK ID#
IL
01
—
7138280
AETNA ID#
IL
Enumeration date
04/02/2007
Last updated
08/22/2020
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