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General NPI Number Information
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NPI Number | 1487145454
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC WELLNESS CENTER OF MT VERNON, LLC.
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 1708 JEFFERSON AVE STE 240
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City | MOUNT VERNON
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State | IL
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Zip | 62864-4309
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Country | US
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Telephone | 618-731-1965
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Fax | 618-316-7206
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Provider Business Mailing Address
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Address Line | 1708 JEFFERSON AVE STE 240
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City | MOUNT VERNON
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State | IL
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Zip | 62864-4309
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Country | US
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Telephone | 618-731-1965
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Fax | 618-316-7206
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Authorized Official
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Title or Position | CHIROPRACTOR/ OWNER
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Name | DR. NICHOLE LAMASTER
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Credential | DC
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Telephone | 618-731-2686
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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 | 038013015
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License Number State | IL
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