Healthcare Provider Details

I. General information

NPI: 1598299422
Provider Name (Legal Business Name): ACCESS HEALTHCARE AND WELLNESS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 S MILL ST
NASHVILLE IL
62263-2072
US

IV. Provider business mailing address

1527 S MILL ST
NASHVILLE IL
62263-2072
US

V. Phone/Fax

Practice location:
  • Phone: 618-327-3224
  • Fax:
Mailing address:
  • Phone: 618-327-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.006254
License Number StateIL

VIII. Authorized Official

Name: DR. RODNEY A SMALL
Title or Position: PRESIDENT
Credential: DC
Phone: 618-327-3224