Provider Demographics
NPI:1801910062
Name:MIDWEST HEALTHCARE CENTER SC
Entity type:Organization
Organization Name:MIDWEST HEALTHCARE CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PENWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-423-1500
Mailing Address - Street 1:2 N COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-4161
Mailing Address - Country:US
Mailing Address - Phone:217-423-1500
Mailing Address - Fax:217-423-1504
Practice Address - Street 1:2 N COUNTRY CLUB RD
Practice Address - Street 2:SUITE 3
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-4161
Practice Address - Country:US
Practice Address - Phone:217-423-1500
Practice Address - Fax:217-423-1504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty