Provider Demographics
NPI:1679679286
Name:REVERMANN CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:REVERMANN CHIROPRACTIC P.C.
Other - Org Name:REVERMANN CHIROPRACTIC AND SPINAL REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:REVERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-526-4700
Mailing Address - Street 1:397 N PLUM ST
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-1528
Mailing Address - Country:US
Mailing Address - Phone:618-526-4134
Mailing Address - Fax:
Practice Address - Street 1:397 N PLUM ST
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-1528
Practice Address - Country:US
Practice Address - Phone:618-526-4134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710984042OtherINDIVIDUAL NPI FOR CRAIG