Healthcare Provider Details

I. General information

NPI: 1205903788
Provider Name (Legal Business Name): R & J HEALTHCARE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 W WASHINGTON ST SUITE 115
OREGON IL
61061-1022
US

IV. Provider business mailing address

1307 W WASHINGTON ST SUITE 115
OREGON IL
61061-1001
US

V. Phone/Fax

Practice location:
  • Phone: 815-732-2826
  • Fax: 815-732-7617
Mailing address:
  • Phone: 815-732-2826
  • Fax: 815-732-7617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. KRANE T CUPPLES
Title or Position: DOCTOR OF CHIROPRACT
Credential: DC
Phone: 815-732-2826