Organization
ILLINOIS VALLEY CHIROPRACTIC, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLEN R PETERSON D.C. (PRESIDENT)
(815) 223-4201
Entity
Organization
Contact information
Practice address
501 1ST ST, LA SALLE, IL 61301-2416
(815) 223-4201
(815) 223-4210
Mailing address
PO BOX 1204, LA SALLE, IL 61301-3204
(815) 223-4201
(815) 223-4210
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
038.008373
IL
Other
Enumeration date
10/18/2010
Last updated
10/18/2010
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