Provider Demographics
NPI:1205104874
Name:CLEM CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:CLEM CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLEM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-438-6324
Mailing Address - Street 1:412 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IL
Mailing Address - Zip Code:62615-1425
Mailing Address - Country:US
Mailing Address - Phone:217-438-6324
Mailing Address - Fax:
Practice Address - Street 1:412 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IL
Practice Address - Zip Code:62615-1425
Practice Address - Country:US
Practice Address - Phone:217-438-6324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009051332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU79997Medicare UPIN