Provider Demographics
NPI:1740165810
Name:BLACKWOOD CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:BLACKWOOD CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERAMY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-520-0222
Mailing Address - Street 1:222 10TH AVE E
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-3120
Mailing Address - Country:US
Mailing Address - Phone:309-520-0222
Mailing Address - Fax:
Practice Address - Street 1:222 10TH AVE E
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264-3120
Practice Address - Country:US
Practice Address - Phone:309-520-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty