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General NPI Number Information
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NPI Number | 1316951635
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Entity Type | Organization
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Legal Business Name | INNER SPIRIT CHIROPRACTIC INC
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 4809 N SHERIDAN RD
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City | PEORIA
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State | IL
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Zip | 61614-5927
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Country | US
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Telephone | 309-685-5777
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Fax | 309-685-5779
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Provider Business Mailing Address
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Address Line | 4809 N SHERIDAN RD
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City | PEORIA
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State | IL
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Zip | 61614-5927
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Country | US
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Telephone | 309-685-5777
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Fax | 309-685-5779
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Authorized Official
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Title or Position | DC
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Name | NICOLE L LACKNER
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Credential | DC
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Telephone | 30968557777
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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 |
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License Number State | IL
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