Provider Demographics
NPI:1124209390
Name:CALLOWAY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:CALLOWAY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-854-3644
Mailing Address - Street 1:228 N CHILES ST
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1606
Mailing Address - Country:US
Mailing Address - Phone:217-854-3644
Mailing Address - Fax:217-854-7107
Practice Address - Street 1:228 N CHILES ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1606
Practice Address - Country:US
Practice Address - Phone:217-854-3644
Practice Address - Fax:217-854-7107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212157Medicare PIN