Provider Demographics
NPI:1801994280
Name:TIBURZI CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:TIBURZI CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:TIBURZI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-854-8001
Mailing Address - Street 1:130 CARLINVILLE PLZ
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1191
Mailing Address - Country:US
Mailing Address - Phone:217-854-8001
Mailing Address - Fax:217-854-3440
Practice Address - Street 1:130 CARLINVILLE PLZ
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1191
Practice Address - Country:US
Practice Address - Phone:217-854-8001
Practice Address - Fax:217-854-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU98676Medicare UPIN
IL210480Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER