Provider Demographics
NPI:1578740452
Name:FERRELL CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:FERRELL CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-628-4488
Mailing Address - Street 1:310 E HIGHWAY 50
Mailing Address - Street 2:SUITE 2
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2700
Mailing Address - Country:US
Mailing Address - Phone:618-628-4488
Mailing Address - Fax:618-628-4474
Practice Address - Street 1:310 E HIGHWAY 50
Practice Address - Street 2:SUITE 2
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2700
Practice Address - Country:US
Practice Address - Phone:618-628-4488
Practice Address - Fax:618-628-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGOtherPENDING
ILPENDINGOtherPENDING