Healthcare Provider Details

I. General information

NPI: 1336554625
Provider Name (Legal Business Name): PREFERRED CARE MEDICAL CENTER LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 S MAIN ST
EUREKA IL
61530-1666
US

IV. Provider business mailing address

1932 S MAIN ST
EUREKA IL
61530-1666
US

V. Phone/Fax

Practice location:
  • Phone: 309-467-5000
  • Fax: 309-467-5100
Mailing address:
  • Phone: 309-467-5000
  • Fax: 309-467-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038010710
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012330
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number036074050
License Number StateIL

VIII. Authorized Official

Name: DR. CARRIE MUSSELMAN
Title or Position: PRESIDENT
Credential:
Phone: 309-467-5000