Healthcare Provider Details

I. General information

NPI: 1154504793
Provider Name (Legal Business Name): COAL VALLEY CHIROPRACTIC CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W 1ST AVE
COAL VALLEY IL
61240-9308
US

IV. Provider business mailing address

102 W 1ST AVE
COAL VALLEY IL
61240-9308
US

V. Phone/Fax

Practice location:
  • Phone: 309-799-7422
  • Fax: 309-799-7401
Mailing address:
  • Phone: 309-799-7422
  • Fax: 309-799-7401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009164
License Number StateIL

VIII. Authorized Official

Name: DR. MICHELLE LEE FRANKLIN
Title or Position: PRESIDENT/TREATING DR.
Credential: D.C.
Phone: 309-799-7422