Provider Demographics
NPI:1831426808
Name:SALT CREEK CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SALT CREEK CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:HOLLENBECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-735-2527
Mailing Address - Street 1:419 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-2019
Mailing Address - Country:US
Mailing Address - Phone:217-735-2527
Mailing Address - Fax:
Practice Address - Street 1:419 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-2019
Practice Address - Country:US
Practice Address - Phone:217-735-2527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty