Provider Demographics
NPI:1770197774
Name:ALIGN SERVICES BLOOMINGTON PLLC
Entity Type:Organization
Organization Name:ALIGN SERVICES BLOOMINGTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINIC
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-843-6098
Mailing Address - Street 1:4812 N SHERIDAN RD STE A700
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5997
Mailing Address - Country:US
Mailing Address - Phone:309-807-4439
Mailing Address - Fax:
Practice Address - Street 1:2309 E EMPIRE ST STE 200A
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-8636
Practice Address - Country:US
Practice Address - Phone:309-807-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty