Provider Demographics
NPI:1841394962
Name:HEALTHY LIFE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:HEALTHY LIFE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SCHMALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-786-3536
Mailing Address - Street 1:2525 24TH ST
Mailing Address - Street 2:STE 204
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201
Mailing Address - Country:US
Mailing Address - Phone:309-786-3536
Mailing Address - Fax:309-794-2156
Practice Address - Street 1:2525 24TH ST
Practice Address - Street 2:STE 204
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201
Practice Address - Country:US
Practice Address - Phone:309-786-3536
Practice Address - Fax:309-794-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8107273OtherBCBS
IA0432609Medicaid
IA0432609Medicaid
212472Medicare ID - Type Unspecified