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General NPI Number Information
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NPI Number | 1295087575
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Entity Type | Organization
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Legal Business Name | PAIN RELIEF CHIROPRACTIC
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 1128 MONROE ST
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City | GALESBURG
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State | IL
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Zip | 61401-2542
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Country | US
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Telephone | 309-343-0028
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Fax |
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Provider Business Mailing Address
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Address Line | 1128 MONROE ST
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City | GALESBURG
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State | IL
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Zip | 61401-2542
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Country | US
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Telephone | 309-343-0028
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFERY WILSON
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Credential | DC
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Telephone | 309-343-0028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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