Provider Demographics
NPI:1033340971
Name:DUQUOIN CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:DUQUOIN CHIROPRACTIC CENTER
Other - Org Name:DUQUOIN HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DICK
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-542-6680
Mailing Address - Street 1:31 S MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-1303
Mailing Address - Country:US
Mailing Address - Phone:618-542-6680
Mailing Address - Fax:618-542-6680
Practice Address - Street 1:31 S MULBERRY ST
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-1303
Practice Address - Country:US
Practice Address - Phone:618-542-6680
Practice Address - Fax:618-542-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008829111N00000X
IL070016013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty