Provider Demographics
NPI:1174657407
Name:HARDIN COUNTY CHIROPRACTIC CENTER INC.
Entity Type:Organization
Organization Name:HARDIN COUNTY CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-252-5555
Mailing Address - Street 1:RR 1 BOX 110C
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62931-9708
Mailing Address - Country:US
Mailing Address - Phone:618-285-4455
Mailing Address - Fax:618-285-4458
Practice Address - Street 1:RR 1 BOX 110C
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:IL
Practice Address - Zip Code:62931-9708
Practice Address - Country:US
Practice Address - Phone:618-285-4455
Practice Address - Fax:618-285-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208796Medicare ID - Type UnspecifiedCLINIC GROUP NO.