Provider Demographics
NPI:1851620728
Name:COMMUNITY CHIROPRACTIC CLINIC SC
Entity Type:Organization
Organization Name:COMMUNITY CHIROPRACTIC CLINIC SC
Other - Org Name:MERIDIAN CHIROPRACTIC AND ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-283-7316
Mailing Address - Street 1:2508 25TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5419
Mailing Address - Country:US
Mailing Address - Phone:309-283-7316
Mailing Address - Fax:309-283-7315
Practice Address - Street 1:2508 25TH ST STE C
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5419
Practice Address - Country:US
Practice Address - Phone:309-283-7316
Practice Address - Fax:309-283-7315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty