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General NPI Number Information
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NPI Number | 1124209390
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Entity Type | Organization
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Legal Business Name | CALLOWAY CHIROPRACTIC PC
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 228 N CHILES ST
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City | CARLINVILLE
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State | IL
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Zip | 62626-1606
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Country | US
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Telephone | 217-854-3644
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Fax | 217-854-7107
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Provider Business Mailing Address
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Address Line | 228 N CHILES ST
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City | CARLINVILLE
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State | IL
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Zip | 62626-1606
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Country | US
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Telephone | 217-854-3644
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Fax | 217-854-7107
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Authorized Official
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Title or Position | OWNER
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Name | KELLY ANNE CALLOWAY
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Credential | DC
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Telephone | 217-854-3644
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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 |
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License Number State | IL
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