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General NPI Number Information
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NPI Number | 1215791660
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Entity Type | Organization
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Legal Business Name | REID FAMILY WELLNESS 2, LLC
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 2920 CHATHAM ROAD, SUITE A
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City | SPRINGFIELD
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State | IL
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Zip | 62704
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Country | US
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Telephone | 217-698-5800
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Fax | 217-698-4863
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Provider Business Mailing Address
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Address Line | 2920 CHATHAM ROAD, SUITE A
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City | SPRINGFIELD
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State | IL
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Zip | 62704
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Country | US
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Telephone | 217-698-5800
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Fax | 217-698-4863
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Authorized Official
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Title or Position | OWNER/MANAGER/CHIROPRACTOR
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Name | MRS. SHAY ELIZABETH SITKO
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Credential | DC
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Telephone | 217-698-5800
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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 |
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