Provider Demographics
NPI:1851647861
Name:FAMILY CHIROPRACTIC CENTER OF MADISON COUNTY
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER OF MADISON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-780-1335
Mailing Address - Street 1:3315 ROBBINS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6587
Mailing Address - Country:US
Mailing Address - Phone:217-698-1111
Mailing Address - Fax:217-698-1110
Practice Address - Street 1:3315 ROBBINS RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6587
Practice Address - Country:US
Practice Address - Phone:217-698-1111
Practice Address - Fax:217-698-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012189261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center