Provider Demographics
NPI:1609040666
Name:DEERE ROAD CHIROPRACTIC LTD.
Entity Type:Organization
Organization Name:DEERE ROAD CHIROPRACTIC LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHWIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-736-7400
Mailing Address - Street 1:5202 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6722
Mailing Address - Country:US
Mailing Address - Phone:309-736-7400
Mailing Address - Fax:309-736-0361
Practice Address - Street 1:5202 38TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6722
Practice Address - Country:US
Practice Address - Phone:309-736-7400
Practice Address - Fax:309-736-0361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-21
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08130289OtherBLUE CROSS BLUE SHIELD
IL1477120OtherFIRST HEALTH
IL08130289OtherBLUE CROSS BLUE SHIELD
IL706500Medicare PIN