Provider Demographics
NPI:1275849101
Name:CHIROPRACTIC CLINIC OF QUINCY, LTD.
Entity Type:Organization
Organization Name:CHIROPRACTIC CLINIC OF QUINCY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:WECKBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-222-4399
Mailing Address - Street 1:422 MAINE STREET
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3930
Mailing Address - Country:US
Mailing Address - Phone:217-222-4399
Mailing Address - Fax:217-222-0480
Practice Address - Street 1:422 MAINE STREET
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3930
Practice Address - Country:US
Practice Address - Phone:217-222-4399
Practice Address - Fax:217-222-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty