Provider Demographics
NPI:1821234154
Name:CRITTER CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:CRITTER CHIROPRACTIC INC.
Other - Org Name:SIMPLY CHIROPRACTIC INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SHOOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-533-2225
Mailing Address - Street 1:211 S PERRINE AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3635
Mailing Address - Country:US
Mailing Address - Phone:618-533-2225
Mailing Address - Fax:
Practice Address - Street 1:211 S PERRINE AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3635
Practice Address - Country:US
Practice Address - Phone:618-533-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW22349OtherMEDICARE PTAN
WYW22350OtherMEDICARE PTAN