Healthcare Provider Details

I. General information

NPI: 1801440557
Provider Name (Legal Business Name): CHRIS NAYOR NTOR-UE DC LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
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: 217-864-4497
Mailing address:
  • Phone: 217-864-5566
  • Fax: 217-330-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198001483
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038013406
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: