Provider Demographics
NPI:1629378872
Name:CHIROPRACTIC SPECIALIST, INC.
Entity Type:Organization
Organization Name:CHIROPRACTIC SPECIALIST, INC.
Other - Org Name:CORE PHYSICIANS GROUP LTD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:VICKERY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-654-3000
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-0142
Mailing Address - Country:US
Mailing Address - Phone:618-654-3000
Mailing Address - Fax:618-654-1567
Practice Address - Street 1:1000 ZSCHOKKE ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1650
Practice Address - Country:US
Practice Address - Phone:618-654-3000
Practice Address - Fax:618-654-1567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty