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General NPI Number Information
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NPI Number | 1396851374
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Entity Type | Organization
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Legal Business Name | CLANAHAN WELLNESS CENTER INC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 105 N PARKWAY DR
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City | PEKIN
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State | IL
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Zip | 61554-3932
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Country | US
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Telephone | 309-353-3300
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Fax | 309-353-7961
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Provider Business Mailing Address
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Address Line | 105 N PARKWAY DR
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City | PEKIN
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State | IL
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Zip | 61554-3932
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Country | US
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Telephone | 309-353-3300
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Fax | 309-353-7961
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Authorized Official
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Title or Position | PRESIDENT
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Name | TODD H CLANAHAN
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Credential | DC
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Telephone | 309-353-3300
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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 | 038008668
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License Number State | IL
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