Provider Demographics
NPI:1659594133
Name:STRUCK CHIROPRACTIC LTD
Entity Type:Organization
Organization Name:STRUCK CHIROPRACTIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:J
Authorized Official - Last Name:STRUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-542-2197
Mailing Address - Street 1:PO BOX 1054
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-5054
Mailing Address - Country:US
Mailing Address - Phone:618-542-2197
Mailing Address - Fax:618-542-2198
Practice Address - Street 1:30 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-1406
Practice Address - Country:US
Practice Address - Phone:618-542-2197
Practice Address - Fax:618-542-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-002706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
132389OtherHEALTH LINK
ILDG4021OtherPALMETTO RR MEDICARE
7382005OtherBLUE CROSS BLUE SHIELD
132389OtherHEALTH LINK
7382005OtherBLUE CROSS BLUE SHIELD