Provider Demographics
NPI:1902188857
Name:CARBONDALE FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CARBONDALE FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BINVERSIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-967-9494
Mailing Address - Street 1:141 FISHBACK RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-6325
Mailing Address - Country:US
Mailing Address - Phone:618-967-9494
Mailing Address - Fax:
Practice Address - Street 1:695 N GIANT CITY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62902-6405
Practice Address - Country:US
Practice Address - Phone:618-967-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012019261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care