Provider Demographics
NPI:1245551613
Name:POINTER CHIROPRACTIC, LLC.
Entity type:Organization
Organization Name:POINTER CHIROPRACTIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:POINTER
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:309-852-6514
Mailing Address - Street 1:627 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-2318
Mailing Address - Country:US
Mailing Address - Phone:309-852-6514
Mailing Address - Fax:309-856-5705
Practice Address - Street 1:627 E 2ND ST
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-2318
Practice Address - Country:US
Practice Address - Phone:309-852-6514
Practice Address - Fax:309-856-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-19
Last Update Date:2010-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038007262Medicaid