Healthcare Provider Details

I. General information

NPI: 1538295266
Provider Name (Legal Business Name): PECATONICA CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 N MAIN ST
PECATONICA IL
61063-9384
US

IV. Provider business mailing address

427 MAIN STREET
PECATONICA IL
61063-9384
US

V. Phone/Fax

Practice location:
  • Phone: 815-239-1121
  • Fax: 815-239-2766
Mailing address:
  • Phone: 815-239-1121
  • Fax: 815-239-2766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-009349
License Number StateIL

VIII. Authorized Official

Name: JEFFREY P GEHLSEN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 815-239-1121