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General NPI Number Information
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NPI Number | 1073932547
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Entity Type | Organization
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Legal Business Name | NIOTA CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 04/14/2014
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 308 ARBOR ST
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City | NIOTA
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State | IL
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Zip | 62358-0134
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Country | US
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Telephone | 217-448-4136
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Fax |
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Provider Business Mailing Address
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Address Line | 308 ARBOR ST PO BOX 0134
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City | NIOTA
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State | IL
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Zip | 62358-1009
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Country | US
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Telephone | 217-448-4136
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. BEN ABRAM O'DELL II
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Credential | D.C.
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Telephone | 217-448-4136
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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 | 038-008899
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License Number State | IL
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