Provider Demographics
NPI:1619092392
Name:SCOTT COUNTY CHIROPRACTIC
Entity Type:Organization
Organization Name:SCOTT COUNTY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-742-5702
Mailing Address - Street 1:38 E CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62694-1002
Mailing Address - Country:US
Mailing Address - Phone:217-742-5705
Mailing Address - Fax:
Practice Address - Street 1:38 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IL
Practice Address - Zip Code:62694-1002
Practice Address - Country:US
Practice Address - Phone:217-742-5705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDE4557OtherRAILROAD MEDICARE
IL8620804OtherBLUE CROSS
ILU98266Medicare UPIN
IL210808Medicare PIN