Provider Demographics
NPI:1164839171
Name:MASCOUTAH CHIROPRACTIC LTD
Entity Type:Organization
Organization Name:MASCOUTAH CHIROPRACTIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNITKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-566-4144
Mailing Address - Street 1:212 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MASCOUTAH
Mailing Address - State:IL
Mailing Address - Zip Code:62258-2421
Mailing Address - Country:US
Mailing Address - Phone:618-566-4144
Mailing Address - Fax:
Practice Address - Street 1:212 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MASCOUTAH
Practice Address - State:IL
Practice Address - Zip Code:62258-2421
Practice Address - Country:US
Practice Address - Phone:618-566-4144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038126642111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty