Provider Demographics
NPI:1003862087
Name:ALLIED HEALTH CHIROPRACTIC CENTERS OF IL, LLC
Entity Type:Organization
Organization Name:ALLIED HEALTH CHIROPRACTIC CENTERS OF IL, LLC
Other - Org Name:ALLIED HEALTH CHIROPRACTIC CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-848-2526
Mailing Address - Street 1:601 S 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3958
Mailing Address - Country:US
Mailing Address - Phone:715-848-2526
Mailing Address - Fax:
Practice Address - Street 1:601 S 32ND AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3958
Practice Address - Country:US
Practice Address - Phone:715-848-2526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCK7346OtherRAILROAD MEDICARE
ILCK6783OtherRAILROAD MEDICARE
IL07232019OtherBLUE CROSS OF IL
ILCK7346OtherRAILROAD MEDICARE
IL07232019OtherBLUE CROSS OF IL
212991Medicare PIN