Healthcare Provider Details

I. General information

NPI: 1346465572
Provider Name (Legal Business Name): CONKLING CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 CAMP JACKSON RD
CAHOKIA IL
62206-2501
US

IV. Provider business mailing address

1407 CAMP JACKSON RD
CAHOKIA IL
62206-2501
US

V. Phone/Fax

Practice location:
  • Phone: 618-332-1212
  • Fax: 618-332-1214
Mailing address:
  • Phone: 618-332-1212
  • Fax: 618-332-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. ROY B CONKLING III
Title or Position: OWNER
Credential: D.C.
Phone: 618-332-1212