Provider Demographics
NPI:1396866091
Name:CHIROM-MED LTD
Entity Type:Organization
Organization Name:CHIROM-MED LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:IVY
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:618-235-3200
Mailing Address - Street 1:3200 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-6620
Mailing Address - Country:US
Mailing Address - Phone:618-235-3200
Mailing Address - Fax:618-235-3282
Practice Address - Street 1:3200 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-6620
Practice Address - Country:US
Practice Address - Phone:618-235-3200
Practice Address - Fax:618-235-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
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
IL40000221OtherUHC ID#
IL400198OtherHELATHLINK ID#
IL7138280OtherAETNA ID#
IL142955OtherCOVENTRY ID#
IL40000221OtherUHC ID#