Provider Demographics
NPI:1851696892
Name:BELVIDERE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:BELVIDERE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:779-552-8358
Mailing Address - Street 1:115 W. LINCOLN AVE. SUITE 2
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-3231
Mailing Address - Country:US
Mailing Address - Phone:779-552-8358
Mailing Address - Fax:779-552-8359
Practice Address - Street 1:115 W LINCOLN AVE STE 2
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-3231
Practice Address - Country:US
Practice Address - Phone:779-552-8358
Practice Address - Fax:779-552-8359
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELVIDERE FAMILY CHIROPRACTIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011702305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization