Provider Demographics
NPI:1386680791
Name:GAYON HIGH PERFORMANCE CHIROPRACTIC & REHAB, INC
Entity Type:Organization
Organization Name:GAYON HIGH PERFORMANCE CHIROPRACTIC & REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAYON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-649-8000
Mailing Address - Street 1:162 E CHESTNUT ST
Mailing Address - Street 2:PO BOX 36
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-2769
Mailing Address - Country:US
Mailing Address - Phone:309-649-8000
Mailing Address - Fax:309-649-8002
Practice Address - Street 1:162 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-2769
Practice Address - Country:US
Practice Address - Phone:309-649-8000
Practice Address - Fax:309-649-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU61117Medicare UPIN