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General NPI Number Information
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NPI Number | 1013318336
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Entity Type | Organization
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Legal Business Name | COTTON CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 09/05/2014
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Provider Practice Location Address
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Address Line | 901 W GLEN AVE SUITE A
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City | PEORIA
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State | IL
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Zip | 61614-4839
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Country | US
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Telephone | 309-693-1212
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Fax | 309-693-2147
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Provider Business Mailing Address
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Address Line | 901 W GLEN AVE SUITE A
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City | PEORIA
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State | IL
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Zip | 61614-4839
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Country | US
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Telephone | 309-693-1212
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Fax | 309-693-2147
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | MR. BRAD A COTTON
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Credential | DC
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Telephone | 309-208-3094
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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 | 038009460
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License Number State | IL
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