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General NPI Number Information
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NPI Number | 1255659645
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Entity Type | Organization
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Legal Business Name | WHOLE BODY HEALTH CENTER, S.C.
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Dates
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Enumeration Date | 05/10/2010
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 105 N 10TH ST STE 4
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City | MATTOON
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State | IL
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Zip | 61938-4158
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Country | US
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Telephone | 217-234-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 105 N 10TH ST STE 4
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City | MATTOON
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State | IL
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Zip | 61938-4158
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Country | US
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Telephone | 217-234-2800
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. JAMIE DEVON STEPHENS
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Credential | D.C.
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Telephone | 217-234-2800
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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 | 38011188
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License Number State | IL
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