Provider Demographics
NPI:1477690865
Name:MIDWEST CHIROPRACTIC CLINIC OF PITTSFIELD, LTD
Entity Type:Organization
Organization Name:MIDWEST CHIROPRACTIC CLINIC OF PITTSFIELD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:MELESKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-285-4122
Mailing Address - Street 1:211 W PERRY ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62363-1109
Mailing Address - Country:US
Mailing Address - Phone:217-285-4122
Mailing Address - Fax:217-285-5157
Practice Address - Street 1:211 W PERRY ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363-1109
Practice Address - Country:US
Practice Address - Phone:217-285-4122
Practice Address - Fax:217-285-5157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350050126OtherRAILROAD MC, MARK MELESKI
IL07521142OtherBCBS IL, GROUP PROV.ID#
IL289076OtherHEALTHLINK GROUP#
ILU61349Medicare UPIN
IL289076OtherHEALTHLINK GROUP#