Provider Demographics
NPI:1629151675
Name:ADVANTAGE FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ADVANTAGE FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MEESE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-234-6000
Mailing Address - Street 1:2347 OLD COLLINSVILLE RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-3194
Mailing Address - Country:US
Mailing Address - Phone:618-234-6000
Mailing Address - Fax:618-234-6009
Practice Address - Street 1:2347 OLD COLLINSVILLE RD
Practice Address - Street 2:SUITE G
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-3194
Practice Address - Country:US
Practice Address - Phone:618-234-6000
Practice Address - Fax:618-234-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-0100779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7821832OtherAETNA
IL769760OtherHEALTH LINK
IL8557360OtherCIGNA PPO
IL08232215OtherBCBS IL
IL1068318OtherCIGNA
IL769760OtherHEALTH LINK
IL7821832OtherAETNA