MEDICARE: DANVILLE CHIROPRACTIC HEALTH CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	111N00000X	Chiropractor	IL
2	111N00000X	Chiropractor	IL
3	111N00000X	Chiropractor	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9232021	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1780642405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANVILLE CHIROPRACTIC HEALTH CLINIC LLC

Provider Business Mailing Address
First Line	:	3817 N VERMILION ST
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-1159
Country	:	US
Telephone Number	:	217-446-4373
Fax Number	:	217-446-4797

Provider Business Practice Location Address
First Line	:	3817 N VERMILION ST
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-1159
Country	:	US
Telephone Number	:	217-446-4373
Fax Number	:	217-446-4797

Authorized Official
Title or Position	:	CEO
Name	:	DR. NATHALIE PELLETIER
Credential	:	D.C.
Telephone Number	:	217-446-4373

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	08/22/2020

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Directions to “DANVILLE CHIROPRACTIC HEALTH CLINIC LLC ” Practice Location

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