Provider Demographics
NPI:1609213487
Name:CLINTON CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:CLINTON CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLUVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-935-6555
Mailing Address - Street 1:203 E SIDE SQ
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-1655
Mailing Address - Country:US
Mailing Address - Phone:217-935-6555
Mailing Address - Fax:217-935-4969
Practice Address - Street 1:203 E SIDE SQ
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-1655
Practice Address - Country:US
Practice Address - Phone:217-935-6555
Practice Address - Fax:217-935-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL8796Medicare PIN