Provider Demographics
NPI:1891066825
Name:THE PATH CENTER FOR HEALING, LLC
Entity Type:Organization
Organization Name:THE PATH CENTER FOR HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:YARDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-343-2398
Mailing Address - Street 1:251 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-4716
Mailing Address - Country:US
Mailing Address - Phone:309-343-2398
Mailing Address - Fax:309-343-2399
Practice Address - Street 1:251 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-4716
Practice Address - Country:US
Practice Address - Phone:309-343-2398
Practice Address - Fax:309-343-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty