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General NPI Number Information
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NPI Number | 1255512596
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Entity Type | Organization
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Legal Business Name | ADVANCED CHIROPRACTIC AND REHABILITATION CENTER, P.C.
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | 2309 VILLAGE GREEN PLACE SUITE B
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City | CHAMPAIGN
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State | IL
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Zip | 61822-6184
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Country | US
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Telephone | 217-355-9900
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Fax | 217-355-9886
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Provider Business Mailing Address
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Address Line | 2309 VILLAGE GREEN PLACE SUITE B
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City | CHAMPAIGN
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State | IL
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Zip | 61822-6184
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Country | US
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Telephone | 217-355-9900
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Fax | 217-355-9886
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. ADAM J CHLADNY
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Credential | D.C.
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Telephone | 217-369-4886
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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 | 038.011019
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License Number State | IL
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