Provider Demographics
NPI:1558571034
Name:KOHLMEIER CHIROPRACTIC THERAPY
Entity Type:Organization
Organization Name:KOHLMEIER CHIROPRACTIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:KOHLMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-939-3033
Mailing Address - Street 1:1329 NORTH ROUTE 3
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298
Mailing Address - Country:US
Mailing Address - Phone:618-939-3033
Mailing Address - Fax:618-282-3971
Practice Address - Street 1:1329 NORTH ROUTE 3
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298
Practice Address - Country:US
Practice Address - Phone:618-939-3033
Practice Address - Fax:618-282-3971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL383378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7982004OtherBCBS
IL187909OtherHEALTH LINK
292590Medicare ID - Type Unspecified
T36082Medicare UPIN