Healthcare Provider Details

I. General information

NPI: 1578633319
Provider Name (Legal Business Name): KENNETH AMTOWER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 BROADMEADOW RD
RANTOUL IL
61866-2122
US

IV. Provider business mailing address

730 BROADMEADOW RD
RANTOUL IL
61866-2122
US

V. Phone/Fax

Practice location:
  • Phone: 217-892-4773
  • Fax:
Mailing address:
  • Phone: 217-892-4773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: