Provider Demographics
NPI:1497020705
Name:BARTONVILLE CHIROPRACTIC OFFICES P.C
Entity type:Organization
Organization Name:BARTONVILLE CHIROPRACTIC OFFICES P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:JOHNIGK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-697-9617
Mailing Address - Street 1:4903 S BECKER DR
Mailing Address - Street 2:
Mailing Address - City:BARTONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61607-2848
Mailing Address - Country:US
Mailing Address - Phone:309-697-9617
Mailing Address - Fax:309-697-9116
Practice Address - Street 1:4903 S BECKER DR
Practice Address - Street 2:
Practice Address - City:BARTONVILLE
Practice Address - State:IL
Practice Address - Zip Code:61607-2848
Practice Address - Country:US
Practice Address - Phone:309-697-9617
Practice Address - Fax:309-697-9116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL267980Medicare PIN