Provider Demographics
NPI:1477597565
Name:BEMIS, DAVID ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIC
Last Name:BEMIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 BELLE STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6117
Mailing Address - Country:US
Mailing Address - Phone:618-465-6500
Mailing Address - Fax:866-460-6962
Practice Address - Street 1:418 BELLE STREET
Practice Address - Street 2:SUITE C
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6117
Practice Address - Country:US
Practice Address - Phone:618-465-6500
Practice Address - Fax:866-460-6962
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006296111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038006296Medicaid
ILT87125Medicare UPIN
IL038006296Medicaid