Provider Demographics
NPI:1205476108
Name:NORTHERN, WILLIAM H (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:NORTHERN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 SOUTH MAIN ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-9998
Mailing Address - Country:US
Mailing Address - Phone:618-719-2350
Mailing Address - Fax:618-234-8295
Practice Address - Street 1:1005 SOUTH MAIN ST.
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-9998
Practice Address - Country:US
Practice Address - Phone:618-719-2350
Practice Address - Fax:618-234-8295
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor