Healthcare Provider Details

I. General information

NPI: 1194151951
Provider Name (Legal Business Name): KLEPZIG NATURAL HEALING CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CIRCLE DR
CHARLESTON IL
61920-2950
US

IV. Provider business mailing address

35 CIRCLE DR
CHARLESTON IL
61920-2950
US

V. Phone/Fax

Practice location:
  • Phone: 217-345-1416
  • Fax: 217-345-1460
Mailing address:
  • Phone: 217-345-1416
  • Fax: 217-345-1460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number038.008290
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198.000357
License Number StateIL

VIII. Authorized Official

Name: DR. BRIAN KEITH KLEPZIG
Title or Position: OWNER
Credential: D.C.,DIPL. AC.,L.AC
Phone: 217-345-1416