Healthcare Provider Details

I. General information

NPI: 1003653692
Provider Name (Legal Business Name): MT. ZION CHIROPRACTIC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E ASHLAND AVE
MT ZION IL
62549-1272
US

IV. Provider business mailing address

103 E ASHLAND AVE
MT ZION IL
62549-1272
US

V. Phone/Fax

Practice location:
  • Phone: 217-864-5566
  • Fax:
Mailing address:
  • Phone: 217-864-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRIS NTOR-UE
Title or Position: PRESIDENT
Credential: DC LAC
Phone: 630-415-9846