Provider Demographics
NPI:1164523338
Name:DR E.L. STROTHEIDE LTD
Entity Type:Organization
Organization Name:DR E.L. STROTHEIDE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:L
Authorized Official - Last Name:STROTHEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-876-7800
Mailing Address - Street 1:3412 NAMEOKI ROAD
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040
Mailing Address - Country:US
Mailing Address - Phone:618-876-7800
Mailing Address - Fax:618-876-7850
Practice Address - Street 1:3412 NAMEOKI ROAD
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040
Practice Address - Country:US
Practice Address - Phone:618-876-7800
Practice Address - Fax:618-876-7850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006145111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
06023887OtherBCBS OF IL
06023887OtherBCBS OF IL
T35450Medicare UPIN
ILGROUP210874Medicare ID - Type Unspecified