Healthcare Provider Details

I. General information

NPI: 1215003744
Provider Name (Legal Business Name): PAUL ROBERT HOOVER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 S PRAIRIE ST
BETHALTO IL
62010-1816
US

IV. Provider business mailing address

440 S PRAIRIE ST
BETHALTO IL
62010-1816
US

V. Phone/Fax

Practice location:
  • Phone: 618-374-7821
  • Fax: 618-377-8217
Mailing address:
  • Phone: 618-374-7821
  • Fax: 618-377-8217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038003928
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: