Provider Demographics
NPI:1376940718
Name:EMPOWER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:EMPOWER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIR-STURTEVANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-855-3061
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61051-0132
Mailing Address - Country:US
Mailing Address - Phone:815-855-3061
Mailing Address - Fax:815-855-3062
Practice Address - Street 1:444 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:IL
Practice Address - Zip Code:61051-9506
Practice Address - Country:US
Practice Address - Phone:815-855-3061
Practice Address - Fax:815-855-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty