Provider Demographics
NPI:1669093670
Name:ILLINOIS HEALTHCENTERS LLC
Entity type:Organization
Organization Name:ILLINOIS HEALTHCENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RACE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-309-9550
Mailing Address - Street 1:1413 SNOWBIRD LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:519 S STATE ST
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2241
Practice Address - Country:US
Practice Address - Phone:330-309-9550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty