Provider Demographics
NPI:1669515037
Name:MIDTOWN CHIROPRACTIC CLINIC S.C.
Entity type:Organization
Organization Name:MIDTOWN CHIROPRACTIC CLINIC S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:SAKALOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-344-4030
Mailing Address - Street 1:444 N HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-3508
Mailing Address - Country:US
Mailing Address - Phone:309-344-4030
Mailing Address - Fax:309-344-4032
Practice Address - Street 1:444 N HENDERSON ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-3508
Practice Address - Country:US
Practice Address - Phone:309-344-4030
Practice Address - Fax:309-344-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDB3897OtherMEDICARE RAILROAD GROUP #
ILDB3897OtherMEDICARE RAILROAD GROUP #
IL04830278Medicare UPIN