Provider Demographics
NPI:1720571532
Name:PRIDE IN YOUR HEALTH PC
Entity Type:Organization
Organization Name:PRIDE IN YOUR HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J. CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-281-3551
Mailing Address - Street 1:1804 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-1023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1804 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-1023
Practice Address - Country:US
Practice Address - Phone:217-281-3551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty