Provider Demographics
NPI:1982677795
Name:CHIROPRACTIC HEALTHCARE PC
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHARPENTIER
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:217-243-3377
Mailing Address - Street 1:1424 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1103
Mailing Address - Country:US
Mailing Address - Phone:217-243-3377
Mailing Address - Fax:217-243-0022
Practice Address - Street 1:1424 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1103
Practice Address - Country:US
Practice Address - Phone:217-243-3377
Practice Address - Fax:217-243-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06907658OtherBCBS
IL795590Medicare PIN