Provider Demographics
NPI:1770642928
Name:SCHWARTZ CHIROPRACTIC CENTRE PC
Entity Type:Organization
Organization Name:SCHWARTZ CHIROPRACTIC CENTRE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-351-2021
Mailing Address - Street 1:1401 S STATE ST STE B
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-6877
Mailing Address - Country:US
Mailing Address - Phone:217-351-2021
Mailing Address - Fax:217-351-1740
Practice Address - Street 1:1401 S STATE ST STE B
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-6877
Practice Address - Country:US
Practice Address - Phone:217-351-2021
Practice Address - Fax:217-351-1740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1015000OtherBLUE CROSS BLUE SHIELD
IL235560Medicare ID - Type Unspecified