Provider Demographics
NPI:1699823096
Name:MILLSTADT FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:MILLSTADT FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOERNSCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-476-3344
Mailing Address - Street 1:500 S ILLINOIS ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MILLSTADT
Mailing Address - State:IL
Mailing Address - Zip Code:62260-1373
Mailing Address - Country:US
Mailing Address - Phone:618-476-3344
Mailing Address - Fax:
Practice Address - Street 1:500 S ILLINOIS ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MILLSTADT
Practice Address - State:IL
Practice Address - Zip Code:62260-1373
Practice Address - Country:US
Practice Address - Phone:618-476-3344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID