Provider Demographics
NPI:1538295266
Name:PECATONICA CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:PECATONICA CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:GEHLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-239-1121
Mailing Address - Street 1:427 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PECATONICA
Mailing Address - State:IL
Mailing Address - Zip Code:61063-9384
Mailing Address - Country:US
Mailing Address - Phone:815-239-1121
Mailing Address - Fax:815-239-2766
Practice Address - Street 1:427 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PECATONICA
Practice Address - State:IL
Practice Address - Zip Code:61063-9384
Practice Address - Country:US
Practice Address - Phone:815-239-1121
Practice Address - Fax:815-239-2766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009349111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty