Provider Demographics
NPI:1982069894
Name:VINCENT CHIROPRACTIC, S.C.
Entity Type:Organization
Organization Name:VINCENT CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-740-1711
Mailing Address - Street 1:120 S DELMAR AVE
Mailing Address - Street 2:SUITE B P.O. BOX 458
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-2000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 S DELMAR AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-2000
Practice Address - Country:US
Practice Address - Phone:618-740-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty