Provider Demographics
NPI:1467460733
Name:MORNINGSTAR CHIROPRACTIC & REHABILITATION CENTER LTD
Entity Type:Organization
Organization Name:MORNINGSTAR CHIROPRACTIC & REHABILITATION CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORNINGSTAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-288-8090
Mailing Address - Street 1:PO BOX 843
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-0843
Mailing Address - Country:US
Mailing Address - Phone:618-288-8090
Mailing Address - Fax:618-288-4422
Practice Address - Street 1:3733 S STATE ROUTE 159
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-3043
Practice Address - Country:US
Practice Address - Phone:618-288-8090
Practice Address - Fax:618-288-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008822111N00000X
IL038004337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06032118OtherBCBS ILLINOIS
IL06032118OtherBCBS ILLINOIS