Healthcare Provider Details

I. General information

NPI: 1992913719
Provider Name (Legal Business Name): HIGH CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 WALTON LANE
ANNA IL
62906
US

IV. Provider business mailing address

12329 PEBBLE POINT RD
MARION IL
62959-8530
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-7014
  • Fax:
Mailing address:
  • Phone: 618-995-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name: ROGER FRANKLIN HIGH
Title or Position: OWNER
Credential:
Phone: 618-833-7014