Provider Demographics
NPI:1669669503
Name:NORTH CLAY FAMILY CHIROPRACTIC,PC
Entity Type:Organization
Organization Name:NORTH CLAY FAMILY CHIROPRACTIC,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-665-3070
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62858-0009
Mailing Address - Country:US
Mailing Address - Phone:618-665-3070
Mailing Address - Fax:217-665-3070
Practice Address - Street 1:101 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:IL
Practice Address - Zip Code:62858-0009
Practice Address - Country:US
Practice Address - Phone:618-665-3070
Practice Address - Fax:217-665-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty