Provider Demographics
NPI:1851129753
Name:HAPPOLD, SAMANTHA (DC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HAPPOLD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4157
Mailing Address - Country:US
Mailing Address - Phone:618-792-0028
Mailing Address - Fax:
Practice Address - Street 1:9 JUNCTION DR W STE 2
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-2931
Practice Address - Country:US
Practice Address - Phone:618-746-8365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor