Provider Demographics
NPI:1669660262
Name:CORE HEALTH GROUP PC
Entity Type:Organization
Organization Name:CORE HEALTH GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-654-3000
Mailing Address - Street 1:1006 WALNUT ST.
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1542
Mailing Address - Country:US
Mailing Address - Phone:618-654-3000
Mailing Address - Fax:618-654-1567
Practice Address - Street 1:1006 WALNUT ST.
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1542
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:2007-10-09
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010972111N00000X
IL038.010972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
215926Medicare UPIN