Provider Demographics
NPI:1568658409
Name:ADVANCED PHYSICIANS HEALTH CARE, S.C.
Entity Type:Organization
Organization Name:ADVANCED PHYSICIANS HEALTH CARE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DURBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-472-7778
Mailing Address - Street 1:501 N MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550
Mailing Address - Country:US
Mailing Address - Phone:309-263-4673
Mailing Address - Fax:309-263-4611
Practice Address - Street 1:1200 WEST LOUCKS AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604
Practice Address - Country:US
Practice Address - Phone:309-682-6624
Practice Address - Fax:309-682-6625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL568780Medicare PIN
ILU77288Medicare UPIN