Provider Demographics
NPI:1619337813
Name:EARNEST, JUSTINA MARIE (DC)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:MARIE
Last Name:EARNEST
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 1:107 S GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:OBLONG
Mailing Address - State:IL
Mailing Address - Zip Code:62449-1465
Mailing Address - Country:US
Mailing Address - Phone:618-592-6505
Mailing Address - Fax:
Practice Address - Street 1:108 S GARFIELD ST
Practice Address - Street 2:
Practice Address - City:OBLONG
Practice Address - State:IL
Practice Address - Zip Code:62449-1464
Practice Address - Country:US
Practice Address - Phone:618-592-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1878111NP0017X
IL038.013145111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor