Provider Demographics
NPI:1225144066
Name:RIVER VALLEY CHIROPRACTIC
Entity Type:Organization
Organization Name:RIVER VALLEY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAMCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-664-4743
Mailing Address - Street 1:427 W DAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-1807
Mailing Address - Country:US
Mailing Address - Phone:815-664-4743
Mailing Address - Fax:
Practice Address - Street 1:427 W DAKOTA ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61362-1807
Practice Address - Country:US
Practice Address - Phone:815-664-4743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9820120OtherBUE CROSS BLUE SHIELD
IL9820120OtherBUE CROSS BLUE SHIELD