Provider Demographics
NPI:1881152288
Name:VERCELLINO PURCHASING CO
Entity type:Organization
Organization Name:VERCELLINO PURCHASING CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:VERCELLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-520-4433
Mailing Address - Street 1:3350 N WATER ST STE A
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-2353
Mailing Address - Country:US
Mailing Address - Phone:217-877-2404
Mailing Address - Fax:217-877-2522
Practice Address - Street 1:3350 N WATER ST STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-2353
Practice Address - Country:US
Practice Address - Phone:217-877-2404
Practice Address - Fax:217-877-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty