Healthcare Provider Details

I. General information

NPI: 1952819971
Provider Name (Legal Business Name): ERIC GERARD TOENNIES DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 E HIGHWAY 50
O FALLON IL
62269
US

IV. Provider business mailing address

902 PHILLIP CT
O FALLON IL
62269-3100
US

V. Phone/Fax

Practice location:
  • Phone: 618-589-9400
  • Fax:
Mailing address:
  • Phone: 618-520-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.013102
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: