Provider Demographics
NPI:1407419807
Name:CHAMPAIGN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CHAMPAIGN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-342-7222
Mailing Address - Street 1:414 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2336
Mailing Address - Country:US
Mailing Address - Phone:217-342-7222
Mailing Address - Fax:217-342-7214
Practice Address - Street 1:1103 W WINDSOR RD
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-6999
Practice Address - Country:US
Practice Address - Phone:217-342-7222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-21
Last Update Date:2019-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty