Provider Demographics
NPI:1629297106
Name:CENTRAL ILLINOIS NATURAL HEALTH CLINIC, LTD.
Entity Type:Organization
Organization Name:CENTRAL ILLINOIS NATURAL HEALTH CLINIC, LTD.
Other - Org Name:CENTRAL ILLINOIS NATURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-443-4372
Mailing Address - Street 1:1012 W FAIRCHILD ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3712
Mailing Address - Country:US
Mailing Address - Phone:217-443-4372
Mailing Address - Fax:217-443-0452
Practice Address - Street 1:1012 W FAIRCHILD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3712
Practice Address - Country:US
Practice Address - Phone:217-443-4372
Practice Address - Fax:217-443-0452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211517Medicare ID - Type Unspecified