Provider Demographics
NPI:1265604755
Name:HOMETOWN CHIROPRACTIC
Entity type:Organization
Organization Name:HOMETOWN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCE
Authorized Official - Middle Name:SILAS
Authorized Official - Last Name:COLL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:618-664-0444
Mailing Address - Street 1:621 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1744
Mailing Address - Country:US
Mailing Address - Phone:618-664-0444
Mailing Address - Fax:618-664-0454
Practice Address - Street 1:621 S 2ND ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1744
Practice Address - Country:US
Practice Address - Phone:618-664-0444
Practice Address - Fax:618-664-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL30340053OtherB.C.B.S. PROVIDER #
IL30340053OtherB.C.B.S. PROVIDER #
IL215225Medicare PIN