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General NPI Number Information
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NPI Number | 1194995217
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Entity Type | Organization
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Legal Business Name | WALNUT CHIROPRACTIC AND ACUPUNCTURE, SC
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 01/13/2010
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Provider Practice Location Address
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Address Line | 860 BIESTER DR SUITE 103
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City | BELVIDERE
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State | IL
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Zip | 61008-4053
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Country | US
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Telephone | 815-544-3894
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Fax | 815-547-3968
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Provider Business Mailing Address
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Address Line | 887 WHITE OAKS DR
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City | DIXON
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State | IL
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Zip | 61021-9057
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Country | US
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Telephone | 815-652-3551
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT ALLEN DYER
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Credential | DC
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Telephone | 815-544-3894
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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 | 038007076
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License Number State | IL
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