Organization
KOMESHAK CHIROPRACTIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK KOMESHAK DC (OWNER)
(618) 236-3600
Entity
Organization
Contact information
Practice address
3030 FRANK SCOTT PKWY W, SUITE 1, BELLEVILLE, IL 62223-5014
(618) 236-3600
(618) 236-3600
Mailing address
3030 FRANK SCOTT PKWY W, SUITE 1, BELLEVILLE, IL 62223-5014
(618) 236-3600
(618) 236-3600
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038008047
IL
225100000X
Physical Therapist
070011807
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08221308
BCBS ILLINOIS
IL
01
—
104259
GHP
—
01
—
DD4196
MEDICARE RAILROAD
—
Enumeration date
10/13/2006
Last updated
02/25/2011
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