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General NPI Number Information
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NPI Number | 1336417724
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Entity Type | Organization
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Legal Business Name | ACUPUNCTURE & CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 716 S 2ND ST
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City | SPRINGFIELD
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State | IL
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Zip | 62704-2516
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Country | US
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Telephone | 217-544-8118
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Fax |
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Provider Business Mailing Address
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Address Line | 716 S 2ND ST
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City | SPRINGFIELD
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State | IL
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Zip | 62704-2516
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Country | US
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Telephone |
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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. LOUIS T DISTASIO
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Credential | D.C. L.AC.
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Telephone | 217-544-8118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 198000025
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 038003935
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License Number State | IL
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