Provider Demographics
NPI:1801172168
Name:SEVERNS FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:SEVERNS FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEVERNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-624-3600
Mailing Address - Street 1:635 WEST US HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:O'FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1941
Mailing Address - Country:US
Mailing Address - Phone:618-624-3600
Mailing Address - Fax:888-886-3168
Practice Address - Street 1:635 W US HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1941
Practice Address - Country:US
Practice Address - Phone:618-624-3600
Practice Address - Fax:888-886-3168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011937261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center