Provider Demographics
NPI:1689783680
Name:SOOLEY CHIROPRACTIC, LTD
Entity Type:Organization
Organization Name:SOOLEY CHIROPRACTIC, LTD
Other - Org Name:SOOLEY CHIROPRACTIC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:SOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-431-3290
Mailing Address - Street 1:11 E FAIRCHILD ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3140
Mailing Address - Country:US
Mailing Address - Phone:217-477-7019
Mailing Address - Fax:
Practice Address - Street 1:11 E FAIRCHILD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3140
Practice Address - Country:US
Practice Address - Phone:217-431-3290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210111Medicare ID - Type UnspecifiedGROUP PROVIDER #
ILDC1548Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP #