Provider Demographics
NPI:1154504793
Name:COAL VALLEY CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:COAL VALLEY CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TREATING DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-799-7422
Mailing Address - Street 1:102 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9308
Mailing Address - Country:US
Mailing Address - Phone:309-799-7422
Mailing Address - Fax:309-799-7401
Practice Address - Street 1:102 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:COAL VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61240-9308
Practice Address - Country:US
Practice Address - Phone:309-799-7422
Practice Address - Fax:309-799-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210237Medicare PIN