Healthcare Provider Details

I. General information

NPI: 1598767576
Provider Name (Legal Business Name): BURCH CHIROPRACTIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N MAIN ST
LEWISTOWN IL
61542-1143
US

IV. Provider business mailing address

510 N MAIN ST
LEWISTOWN IL
61542-1143
US

V. Phone/Fax

Practice location:
  • Phone: 309-547-2343
  • Fax:
Mailing address:
  • Phone: 309-547-2343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038002991
License Number State

VIII. Authorized Official

Name: JAMES V BURCH
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 309-547-2343