Healthcare Provider Details

I. General information

NPI: 1033340971
Provider Name (Legal Business Name): DUQUOIN CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 S MULBERRY ST
DU QUOIN IL
62832-1303
US

IV. Provider business mailing address

31 S MULBERRY ST
DU QUOIN IL
62832-1303
US

V. Phone/Fax

Practice location:
  • Phone: 618-542-6680
  • Fax: 618-542-6680
Mailing address:
  • Phone: 618-542-6680
  • Fax: 618-542-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038008829
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070016013
License Number StateIL

VIII. Authorized Official

Name: DR. ROBERT DICK EATON
Title or Position: OWNER
Credential: DC
Phone: 618-542-6680