Healthcare Provider Details

I. General information

NPI: 1720040694
Provider Name (Legal Business Name): PAMELA JEAN KOTSCHEVAR D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E WOOD ST
HILLSBORO IL
62049-1526
US

IV. Provider business mailing address

PO BOX 464
HILLSBORO IL
62049-0464
US

V. Phone/Fax

Practice location:
  • Phone: 217-532-9461
  • Fax: 217-532-9461
Mailing address:
  • Phone: 217-532-9461
  • Fax: 217-532-9461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-005607
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: