Provider Demographics
NPI:1184789018
Name:MCCONNAUGHY CHIROPRACTIC CLINIC P.C.
Entity type:Organization
Organization Name:MCCONNAUGHY CHIROPRACTIC CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MCCONNAUGHY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-985-4344
Mailing Address - Street 1:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-0394
Mailing Address - Country:US
Mailing Address - Phone:618-985-4344
Mailing Address - Fax:618-985-6469
Practice Address - Street 1:1027 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-0394
Practice Address - Country:US
Practice Address - Phone:618-985-4344
Practice Address - Fax:618-985-6469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004817111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038004817Medicaid
IL208407Medicare PIN
IL038004817Medicaid