=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457982472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSAN MARIE NEUHALFEN NEUHALFEN CHIROPRACTIC CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2020
-----------------------------------------------------
Last Update Date | 11/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 N TREMONT ST
-----------------------------------------------------
City | KEWANEE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61443-2231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-856-5034
-----------------------------------------------------
Fax | 309-856-5034
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 N TREMONT ST
-----------------------------------------------------
City | KEWANEE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61443-2231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-856-5034
-----------------------------------------------------
Fax | 309-856-5034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | SUSAN M KAUFMAN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 815-878-8249
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------