Provider Demographics
NPI:1801929716
Name:CHEELY CHIROPRACTIC CLINIC LTD
Entity type:Organization
Organization Name:CHEELY CHIROPRACTIC CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHEELY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-259-3333
Mailing Address - Street 1:131 N BELLWOOD DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-2088
Mailing Address - Country:US
Mailing Address - Phone:618-259-3333
Mailing Address - Fax:618-259-3334
Practice Address - Street 1:131 N BELLWOOD DR
Practice Address - Street 2:SUITE D
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-2088
Practice Address - Country:US
Practice Address - Phone:618-259-3333
Practice Address - Fax:618-259-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042 007970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6082035OtherBLUE CROSS BLUE SHIELD
IL1346314333OtherINDIVIDUAL NPI
IL350053197OtherRR MEDICARE
IL350053197OtherRR MEDICARE
IL6889000Medicare ID - Type Unspecified