Provider Demographics
NPI:1568565182
Name:BIRDSELL, DAVID R (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:BIRDSELL
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 1:1201 5TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-1331
Mailing Address - Country:US
Mailing Address - Phone:309-764-8821
Mailing Address - Fax:309-757-4773
Practice Address - Street 1:1201 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-1331
Practice Address - Country:US
Practice Address - Phone:309-764-8821
Practice Address - Fax:309-757-4773
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK46492Medicare PIN