Healthcare Provider Details

I. General information

NPI: 1073394086
Provider Name (Legal Business Name): SHILO TROWBRIDGE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N COUNTY ROAD 1100E
LERNA IL
62440-2727
US

IV. Provider business mailing address

509 N COUNTY ROAD 1100E
LERNA IL
62440-2727
US

V. Phone/Fax

Practice location:
  • Phone: 217-218-0815
  • Fax:
Mailing address:
  • Phone: 217-218-0815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.014022
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: