Organization
MOUNT VERNON CHIROPRACTIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY RAY DRAKE D.C. (CHIROPRACTOR)
(618) 242-4554
Entity
Organization
Contact information
Practice address
1315 MAIN ST, MOUNT VERNON, IL 62864-3720
(618) 242-4554
(618) 242-4653
Mailing address
1315 MAIN ST, MOUNT VERNON, IL 62864-3720
(618) 242-4554
(618) 242-4653
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
038006100
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038006100
—
IL
01
—
350027546
PALMETTO RR MEDICARE
IL
01
—
4182010
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/29/2007
Last updated
08/29/2007
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