Provider Demographics
NPI:1740452366
Name:GARY CHIROPRACTIC OFFICES PC
Entity type:Organization
Organization Name:GARY CHIROPRACTIC OFFICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-324-6424
Mailing Address - Street 1:201 N JACKSON
Mailing Address - Street 2:
Mailing Address - City:LITHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-2009
Mailing Address - Country:US
Mailing Address - Phone:217-324-6424
Mailing Address - Fax:217-324-6424
Practice Address - Street 1:201 N JACKSON
Practice Address - Street 2:
Practice Address - City:LITHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-2009
Practice Address - Country:US
Practice Address - Phone:217-324-6424
Practice Address - Fax:217-324-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL38003368Medicaid
IL292560Medicare PIN
ILT36080Medicare UPIN