Healthcare Provider Details

I. General information

NPI: 1912125097
Provider Name (Legal Business Name): RIVERSIDE CHIROPRACTIC CENTER OF SENECA,LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 SO MAIN ST.
SENECA IL IL
61360
US

IV. Provider business mailing address

260 SO MAIN ST.
SENECA IL
61360
US

V. Phone/Fax

Practice location:
  • Phone: 815-357-6858
  • Fax: 815-357-6857
Mailing address:
  • Phone: 815-357-6858
  • Fax: 815-357-6857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number060-007446
License Number StateIL

VIII. Authorized Official

Name: DR. CHRISTA MARIE VELOS
Title or Position: PRESIDENT
Credential: D.C., DICCP
Phone: 815-357-6858