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General NPI Number Information
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NPI Number | 1366737900
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Entity Type | Organization
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Legal Business Name | HEALING HANDS CHIROPRACTIC, PC
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Dates
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Enumeration Date | 06/11/2011
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Last Update Date | 06/11/2011
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Provider Practice Location Address
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Address Line | 2801 BROADWAY ST
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City | MOUNT VERNON
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State | IL
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Zip | 62864-2380
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Country | US
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Telephone | 618-244-2444
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 BROADWAY ST
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City | MOUNT VERNON
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State | IL
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Zip | 62864-2380
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Country | US
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Telephone | 618-244-2444
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CAROL GEPHART
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Credential | DC
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Telephone | 618-244-2444
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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 | 038.011734
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License Number State | IL
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