Provider Demographics
NPI:1578843835
Name:PRIDE IN YOUR HEALTH HOLISTIC CLINIC PC
Entity Type:Organization
Organization Name:PRIDE IN YOUR HEALTH HOLISTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:B
Authorized Official - Last Name:PRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-359-0707
Mailing Address - Street 1:110 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-4107
Mailing Address - Country:US
Mailing Address - Phone:217-359-0707
Mailing Address - Fax:217-359-0710
Practice Address - Street 1:110 N 1ST ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-4107
Practice Address - Country:US
Practice Address - Phone:217-359-0707
Practice Address - Fax:217-359-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty