Healthcare Provider Details

I. General information

NPI: 1851647861
Provider Name (Legal Business Name): FAMILY CHIROPRACTIC CENTER OF MADISON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 ROBBINS RD
SPRINGFIELD IL
62704-6587
US

IV. Provider business mailing address

3315 ROBBINS RD
SPRINGFIELD IL
62704-6587
US

V. Phone/Fax

Practice location:
  • Phone: 217-698-1111
  • Fax: 217-698-1110
Mailing address:
  • Phone: 217-698-1111
  • Fax: 217-698-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number038.012189
License Number StateIL

VIII. Authorized Official

Name: DR. JENNIFER CHATHAM
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 618-780-1335