Provider Demographics
NPI:1932383734
Name:DEYO CHIROPRACTIC CENTER LTD
Entity Type:Organization
Organization Name:DEYO CHIROPRACTIC CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEYO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-244-2091
Mailing Address - Street 1:702 S EAST ST
Mailing Address - Street 2:PO BOX 147
Mailing Address - City:MT CARROLL
Mailing Address - State:IL
Mailing Address - Zip Code:61053
Mailing Address - Country:US
Mailing Address - Phone:815-244-2091
Mailing Address - Fax:
Practice Address - Street 1:702 S EAST ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARROLL
Practice Address - State:IL
Practice Address - Zip Code:61053
Practice Address - Country:US
Practice Address - Phone:815-244-2091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL250580Medicare PIN