Provider Demographics
NPI:1225061955
Name:CHIRO-MED II, LTD
Entity Type:Organization
Organization Name:CHIRO-MED II, LTD
Other - Org Name:REGENERATIVE NEUROPATHY OF OFALLON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-581-5370
Mailing Address - Street 1:1480 N GREEN MOUNT RD STE 300
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-3466
Mailing Address - Country:US
Mailing Address - Phone:618-622-2222
Mailing Address - Fax:618-624-8357
Practice Address - Street 1:1480 N GREEN MOUNT RD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3466
Practice Address - Country:US
Practice Address - Phone:618-622-2222
Practice Address - Fax:618-624-8357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1215964143OtherINDIVIDUAL NPI