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General NPI Number Information
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NPI Number | 1013210152
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Entity Type | Organization
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Legal Business Name | WILLARETH CLINIC OF CHIROPRACTIC LTD.
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 118 E. JACKSON ST
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City | MORRIS
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State | IL
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Zip | 60450-1891
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Country | US
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Telephone | 815-942-5350
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Fax | 815-942-5414
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Provider Business Mailing Address
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Address Line | 118 E. JACKSON ST
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City | MORRIS
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State | IL
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Zip | 60450-1891
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Country | US
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Telephone | 815-942-5350
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Fax | 815-942-5414
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Authorized Official
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Title or Position | PRES
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Name | DR. GLENN C WILLARETH
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Credential | DC
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Telephone | 815-942-5350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC38-3315
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License Number State | IL
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