Provider Demographics
NPI:1326249087
Name:7TH STREET CHIROPRACTIC & ACUPUNCTURE CENTER, PC
Entity Type:Organization
Organization Name:7TH STREET CHIROPRACTIC & ACUPUNCTURE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ANTOLIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-762-1431
Mailing Address - Street 1:3135 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5970
Mailing Address - Country:US
Mailing Address - Phone:309-762-1431
Mailing Address - Fax:309-762-2680
Practice Address - Street 1:3135 7TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5970
Practice Address - Country:US
Practice Address - Phone:309-762-1431
Practice Address - Fax:309-762-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU95245Medicare UPIN
IL205755Medicare ID - Type Unspecified