Provider Demographics
NPI:1033374111
Name:UPTOWN CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:UPTOWN CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRIST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-762-1002
Mailing Address - Street 1:1914 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3953
Mailing Address - Country:US
Mailing Address - Phone:309-762-1002
Mailing Address - Fax:309-736-3484
Practice Address - Street 1:1914 16TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3953
Practice Address - Country:US
Practice Address - Phone:309-762-1002
Practice Address - Fax:309-736-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty