Provider Demographics
NPI:1891902466
Name:ALL CREATURES CHIROPRACTIC OF BROOKPORT, SC
Entity Type:Organization
Organization Name:ALL CREATURES CHIROPRACTIC OF BROOKPORT, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LLANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-564-9094
Mailing Address - Street 1:521 OHIO ST
Mailing Address - Street 2:PO BOX 157
Mailing Address - City:BROOKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:62910-0157
Mailing Address - Country:US
Mailing Address - Phone:618-564-9094
Mailing Address - Fax:618-564-9095
Practice Address - Street 1:521 OHIO ST
Practice Address - Street 2:
Practice Address - City:BROOKPORT
Practice Address - State:IL
Practice Address - Zip Code:62910
Practice Address - Country:US
Practice Address - Phone:618-564-9094
Practice Address - Fax:618-564-9095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0006432011OtherBCBS OF ILLINOIS
IL212591Medicare ID - Type Unspecified