Provider Demographics
NPI:1598837049
Name:SCHNACK, MONICA E (DC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:E
Last Name:SCHNACK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 JACOBSSEN DR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-2499
Mailing Address - Country:US
Mailing Address - Phone:309-452-9097
Mailing Address - Fax:309-452-8269
Practice Address - Street 1:2100 JACOBSSEN DR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2499
Practice Address - Country:US
Practice Address - Phone:309-452-9097
Practice Address - Fax:309-452-8269
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05723664OtherBLUE CROSSBLUE SHIELD
IL902860Medicare ID - Type Unspecified
IL05723664OtherBLUE CROSSBLUE SHIELD