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General NPI Number Information
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NPI Number | 1457669723
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Entity Type | Organization
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Legal Business Name | POSITIVE CHANGES CHIROPRACTIC, LTD
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 09/20/2010
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Provider Practice Location Address
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Address Line | 5724B ELEVATOR RD
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City | ROSCOE
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State | IL
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Zip | 61073-8878
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Country | US
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Telephone | 815-623-8214
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Fax | 815-623-5485
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Provider Business Mailing Address
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Address Line | 5724B ELEVATOR RD
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City | ROSCOE
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State | IL
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Zip | 61073-8878
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Country | US
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Telephone | 815-623-8214
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Fax | 815-623-5485
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC/OWNER
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Name | DR. ANDRENA LYNN SAYLES
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Credential | D.C.
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Telephone | 815-623-8214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 038009552
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License Number State | IL
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