Provider Demographics
NPI:1619346020
Name:FAMILY HEALTH AND WELLNESS CHIROPRACTIC
Entity Type:Organization
Organization Name:FAMILY HEALTH AND WELLNESS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SKERTICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-324-5205
Mailing Address - Street 1:101 N OLD ROUTE 66 STE A
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-2639
Mailing Address - Country:US
Mailing Address - Phone:217-324-5205
Mailing Address - Fax:
Practice Address - Street 1:101 N OLD ROUTE 66 STE A
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-2639
Practice Address - Country:US
Practice Address - Phone:217-324-5205
Practice Address - Fax:618-391-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012873261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF100250904OtherMEDICARE