=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174663215
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRUCTURAL HEALTH CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 02/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 808 W. ROUTE 30
-----------------------------------------------------
City | ROCK FALLS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-626-1887
-----------------------------------------------------
Fax | 815-626-9602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 808 W. ROUTE 30
-----------------------------------------------------
City | ROCK FALLS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-626-1887
-----------------------------------------------------
Fax | 815-626-9602
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RON D. STONITSCH
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 815-626-1887
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038-008977
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038-008975
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------