Provider Demographics
NPI:1255659645
Name:WHOLE BODY HEALTH CENTER, S.C.
Entity Type:Organization
Organization Name:WHOLE BODY HEALTH CENTER, S.C.
Other - Org Name:GO CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:DEVON
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-234-2800
Mailing Address - Street 1:105 N 10TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4158
Mailing Address - Country:US
Mailing Address - Phone:217-234-2800
Mailing Address - Fax:
Practice Address - Street 1:105 N 10TH ST STE 4
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4158
Practice Address - Country:US
Practice Address - Phone:217-234-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38011188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty