Provider Demographics
NPI:1881768737
Name:LILES CHIROPRACTIC CLINIC LTD.
Entity type:Organization
Organization Name:LILES CHIROPRACTIC CLINIC LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:LILES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-369-4974
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:LENA
Mailing Address - State:IL
Mailing Address - Zip Code:61048-0424
Mailing Address - Country:US
Mailing Address - Phone:815-369-4974
Mailing Address - Fax:815-369-4975
Practice Address - Street 1:238 W MAIN ST.
Practice Address - Street 2:
Practice Address - City:LENA
Practice Address - State:IL
Practice Address - Zip Code:61048-9770
Practice Address - Country:US
Practice Address - Phone:815-369-4974
Practice Address - Fax:815-369-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
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
IL01582005OtherBLUE CROSS & BLUE SHIELD
IL01582005OtherBLUE CROSS & BLUE SHIELD