Provider Demographics
NPI:1851526107
Name:PORTER CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:PORTER CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:I
Authorized Official - Credentials:DR
Authorized Official - Phone:618-465-1778
Mailing Address - Street 1:1121 MILTON RD
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-3153
Mailing Address - Country:US
Mailing Address - Phone:618-465-1778
Mailing Address - Fax:618-465-0115
Practice Address - Street 1:1121 MILTON RD
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-3153
Practice Address - Country:US
Practice Address - Phone:618-465-1778
Practice Address - Fax:618-465-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004782302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization