Provider Demographics
NPI:1760664353
Name:CREAMEAN CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:CREAMEAN CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CREAMEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-844-3803
Mailing Address - Street 1:820 W HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-1603
Mailing Address - Country:US
Mailing Address - Phone:815-844-3803
Mailing Address - Fax:815-844-3803
Practice Address - Street 1:820 W HOWARD ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-1603
Practice Address - Country:US
Practice Address - Phone:815-844-3803
Practice Address - Fax:815-844-3803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009217261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009217Medicaid
IL204940Medicare PIN
ILU94177Medicare UPIN