Healthcare Provider Details

I. General information

NPI: 1467460733
Provider Name (Legal Business Name): MORNINGSTAR CHIROPRACTIC & REHABILITATION CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3733 S STATE ROUTE 159
GLEN CARBON IL
62034-3043
US

IV. Provider business mailing address

PO BOX 843
GLEN CARBON IL
62034-0843
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-8090
  • Fax: 618-288-4422
Mailing address:
  • Phone: 618-288-8090
  • Fax: 618-288-4422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038004337
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038008822
License Number StateIL

VIII. Authorized Official

Name: ANDREW L. MORNINGSTAR
Title or Position: OWNER
Credential: DC
Phone: 618-288-8090