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General NPI Number Information
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NPI Number | 1245551613
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Entity Type | Organization
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Legal Business Name | POINTER CHIROPRACTIC, LLC.
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Dates
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Enumeration Date | 06/19/2010
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Last Update Date | 06/19/2010
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Provider Practice Location Address
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Address Line | 627 E 2ND ST
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City | KEWANEE
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State | IL
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Zip | 61443-2318
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Country | US
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Telephone | 309-852-6514
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Fax | 309-856-5705
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Provider Business Mailing Address
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Address Line | 627 E 2ND ST
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City | KEWANEE
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State | IL
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Zip | 61443-2318
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Country | US
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Telephone | 309-852-6514
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Fax | 309-856-5705
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Authorized Official
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Title or Position | OWNER
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Name | DR. GORDON MICHAEL POINTER
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Credential | CHIROPRACTOR
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Telephone | 309-852-6514
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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 | 038007262
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License Number State | IL
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