Provider Demographics
NPI:1093906240
Name:CHIROPRACTIC WORKS LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC WORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:CA
Authorized Official - Phone:618-524-8300
Mailing Address - Street 1:723 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-1633
Mailing Address - Country:US
Mailing Address - Phone:618-524-8300
Mailing Address - Fax:618-524-8607
Practice Address - Street 1:723 MARKET ST
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960-1633
Practice Address - Country:US
Practice Address - Phone:618-524-8300
Practice Address - Fax:618-524-8607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
211962OtherGROUP NUMBER