Provider Demographics
NPI:1265649289
Name:COMBS CHIROPRACTIC AND WELLNESS CENTER S.C.
Entity Type:Organization
Organization Name:COMBS CHIROPRACTIC AND WELLNESS CENTER S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-549-0038
Mailing Address - Street 1:1200 W POLK AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-1713
Mailing Address - Country:US
Mailing Address - Phone:217-345-1011
Mailing Address - Fax:
Practice Address - Street 1:1200 WEST POLK AVE.
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920
Practice Address - Country:US
Practice Address - Phone:217-345-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.010855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K37912Medicare UPIN