Provider Demographics
NPI:1457424632
Name:TLC FOOT DOC, LTD
Entity type:Organization
Organization Name:TLC FOOT DOC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:618-546-2591
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-0185
Mailing Address - Country:US
Mailing Address - Phone:618-546-2591
Mailing Address - Fax:618-546-2668
Practice Address - Street 1:1000 N. ALLEN STREET
Practice Address - Street 2:CMH-CONSULTING CLINIC
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454
Practice Address - Country:US
Practice Address - Phone:618-546-2591
Practice Address - Fax:618-546-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-007976213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5180750002Medicare NSC