Healthcare Provider Details

I. General information

NPI: 1922180975
Provider Name (Legal Business Name): ROBERT ALLAN CROTHERS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W PINE ST STE 2
CHILLICOTHEE IL
61523-1849
US

IV. Provider business mailing address

300 W PINE ST STE 2
CHILLICOTHEE IL
61523-1849
US

V. Phone/Fax

Practice location:
  • Phone: 309-274-9400
  • Fax: 309-274-9430
Mailing address:
  • Phone: 309-274-9400
  • Fax: 309-274-9430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009697
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: