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General NPI Number Information
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NPI Number | 1063885895
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Entity Type | Organization
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Legal Business Name | RICHIE CHIROPRACTIC HEALTH CENTRE
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Dates
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Enumeration Date | 11/02/2015
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 2205 WABASH AVE SUITE 107
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City | SPRINGFIELD
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State | IL
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Zip | 62704-5354
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Country | US
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Telephone | 217-698-2779
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Fax | 217-698-7507
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Provider Business Mailing Address
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Address Line | 2205 WABASH AVE SUITE 107
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City | SPRINGFIELD
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State | IL
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Zip | 62704-5354
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Country | US
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Telephone | 217-698-2779
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Fax | 217-698-7507
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Authorized Official
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Title or Position | OWNER
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Name | LOREN W RICHIE
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Credential | D.C.
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Telephone | 217-698-2779
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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 | 038.008580
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License Number State | IL
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