Provider Demographics
NPI:1134851124
Name:PRINCETON CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:PRINCETON CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEISZ BERTOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-210-2090
Mailing Address - Street 1:222 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-1727
Mailing Address - Country:US
Mailing Address - Phone:815-875-3861
Mailing Address - Fax:
Practice Address - Street 1:222 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-1727
Practice Address - Country:US
Practice Address - Phone:815-875-3861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty