Healthcare Provider Details

I. General information

NPI: 1366774150
Provider Name (Legal Business Name): SCHOAF FAMILY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S. FIRST AVE.
FORRESTON IL
61030-0307
US

IV. Provider business mailing address

210 S. FIRST AVE.
FORRESTON IL
61030-0307
US

V. Phone/Fax

Practice location:
  • Phone: 815-821-3456
  • Fax:
Mailing address:
  • Phone: 815-821-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-008283
License Number StateIL

VIII. Authorized Official

Name: DR. DANIEL SCHOAF
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 815-821-3456