Provider Demographics
NPI:1154330546
Name:CLARION HEALING CENTER, LTD
Entity Type:Organization
Organization Name:CLARION HEALING CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-594-3671
Mailing Address - Street 1:971 EULA MAE PKWY
Mailing Address - Street 2:
Mailing Address - City:CARLYLE
Mailing Address - State:IL
Mailing Address - Zip Code:62231-2401
Mailing Address - Country:US
Mailing Address - Phone:618-594-3671
Mailing Address - Fax:618-594-8058
Practice Address - Street 1:971 EULA MAE PKWY
Practice Address - Street 2:
Practice Address - City:CARLYLE
Practice Address - State:IL
Practice Address - Zip Code:62231-6400
Practice Address - Country:US
Practice Address - Phone:618-594-3671
Practice Address - Fax:618-594-8058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004879111N00000X
IL038006845111N00000X
IL036101959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty