Provider Demographics
NPI:1770779480
Name:EBALO, CATHERINE SUZANNE (DC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SUZANNE
Last Name:EBALO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:SCHEFFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1608 10TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-1405
Mailing Address - Country:US
Mailing Address - Phone:309-755-0323
Mailing Address - Fax:309-755-9192
Practice Address - Street 1:1608 10TH ST
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-1405
Practice Address - Country:US
Practice Address - Phone:309-755-0323
Practice Address - Fax:309-755-9192
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor