Healthcare Provider Details

I. General information

NPI: 1467574731
Provider Name (Legal Business Name): ALLIED HEALTH GROUP, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 VISA DR
NORMAL IL
61761-2131
US

IV. Provider business mailing address

1603 VISA DR
NORMAL IL
61761-2131
US

V. Phone/Fax

Practice location:
  • Phone: 309-268-9000
  • Fax: 309-268-9003
Mailing address:
  • Phone: 309-268-9000
  • Fax: 309-268-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.009648
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number038.009648
License Number StateIL

VIII. Authorized Official

Name: PATRICIA ZVONAR
Title or Position: BILLING SPECIALIST
Credential:
Phone: 309-268-9000