Provider Demographics
NPI:1922132703
Name:RIVERVIEW CHIROPRACTIC AND WELLNESS CLINIC
Entity Type:Organization
Organization Name:RIVERVIEW CHIROPRACTIC AND WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:RATIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-254-9141
Mailing Address - Street 1:14722 S. NAPERVILLE RD
Mailing Address - Street 2:UNIT 100
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544
Mailing Address - Country:US
Mailing Address - Phone:815-254-9141
Mailing Address - Fax:815-254-9184
Practice Address - Street 1:14722 S. NAPERVILLE RD
Practice Address - Street 2:UNIT 100
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544
Practice Address - Country:US
Practice Address - Phone:815-254-9141
Practice Address - Fax:815-254-9184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02226022OtherBCBS OF IL
IL========= 0002OtherCIGNA
IL========= 0002OtherCIGNA
ILU75403Medicare UPIN