Provider Demographics
NPI:1477887537
Name:HEALTHY BODY...HEALTHY LIFE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:HEALTHY BODY...HEALTHY LIFE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:OSBORNE-KIRKEMO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-368-5141
Mailing Address - Street 1:311 E MAIN ST STE 417
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-4867
Mailing Address - Country:US
Mailing Address - Phone:309-368-5141
Mailing Address - Fax:
Practice Address - Street 1:311 E MAIN ST STE 417
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-4867
Practice Address - Country:US
Practice Address - Phone:309-368-5141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2707OtherMEDICARE PTAN
IL01921738OtherBCBS
1831202472OtherNPI
IL01921738OtherBCBS
IL2707OtherMEDICARE PTAN