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General NPI Number Information
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NPI Number | 1285874875
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Entity Type | Organization
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Legal Business Name | IDEAL HEALTH AND WEIGHT LOSS, INC.
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Dates
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Enumeration Date | 02/23/2009
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Last Update Date | 12/05/2014
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Provider Practice Location Address
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Address Line | 810 WEST HWY 50
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City | O'FALLON
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State | IL
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Zip | 62269-6636
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Country | US
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Telephone | 618-406-9920
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Fax |
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Provider Business Mailing Address
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Address Line | 810 WEST HWY 50
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City | O'FALLON
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State | IL
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Zip | 62269-6636
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Country | US
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Telephone | 618-406-9920
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JASON CHRISTOPHER WALKER
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Credential | DC
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Telephone | 618-406-9920
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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 | 038008443
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License Number State | IL
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