Provider Demographics
NPI:1619346871
Name:CASEY FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CASEY FAMILY CHIROPRACTIC LLC
Other - Org Name:CHAMPAIGN CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-243-5313
Mailing Address - Street 1:1515 W WALNUT ST STE 6
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1157
Mailing Address - Country:US
Mailing Address - Phone:217-243-5313
Mailing Address - Fax:217-243-7608
Practice Address - Street 1:1515 W WALNUT ST STE 6
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1157
Practice Address - Country:US
Practice Address - Phone:217-243-5313
Practice Address - Fax:217-243-7608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty