Healthcare Provider Details

I. General information

NPI: 1700104064
Provider Name (Legal Business Name): MIDWEST CHIROPRACTIC CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 TOWANDA AVE SUITE 16
BLOOMINGTON IL
61701-3454
US

IV. Provider business mailing address

1210 TOWANDA AVE SUITE 16
BLOOMINGTON IL
61701-3454
US

V. Phone/Fax

Practice location:
  • Phone: 309-829-1010
  • Fax: 309-829-0142
Mailing address:
  • Phone: 309-829-1010
  • Fax: 309-829-0142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number038003573
License Number StateIL

VIII. Authorized Official

Name: DR. DONALD WILLIAM HANKINS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 309-829-1010