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General NPI Number Information
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NPI Number | 1366705113
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Entity Type | Organization
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Legal Business Name | ADAMS ENTERPRISES OF EAST CENTRAL ILLINOIS PC
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 1109 N STATE ST
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City | MONTICELLO
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State | IL
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Zip | 61856-1175
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Country | US
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Telephone | 217-762-8576
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Fax | 217-762-8578
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Provider Business Mailing Address
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Address Line | PO BOX 235
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City | MONTICELLO
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State | IL
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Zip | 61856-0235
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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 | PRESIDENT
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Name | GAY LYNNE ADAMS
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Credential | DC
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Telephone | 217-762-8576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 038-007231
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License Number State | IL
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