Provider Demographics
NPI:1841708351
Name:SITKO CHIROPRACTIC 2, LLC
Entity type:Organization
Organization Name:SITKO CHIROPRACTIC 2, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SITKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-525-2035
Mailing Address - Street 1:205 N GRAND AVE W
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-2550
Mailing Address - Country:US
Mailing Address - Phone:217-525-2035
Mailing Address - Fax:217-525-2303
Practice Address - Street 1:205 N GRAND AVE W
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-2550
Practice Address - Country:US
Practice Address - Phone:217-525-2035
Practice Address - Fax:217-525-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-013178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty