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General NPI Number Information
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NPI Number | 1487833992
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Entity Type | Organization
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Legal Business Name | BLOOMINGTON CHIROPRACTIC CENTER, LTD.
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 409 S PROSPECT RD SUITE A
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City | BLOOMINGTON
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State | IL
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Zip | 61704-4581
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Country | US
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Telephone | 309-663-8388
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Fax | 309-663-0929
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Provider Business Mailing Address
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Address Line | 409 S PROSPECT RD SUITE A
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City | BLOOMINGTON
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State | IL
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Zip | 61704-4581
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Country | US
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Telephone | 309-663-8388
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Fax | 309-663-0929
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Authorized Official
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Title or Position | SENIOR ASSOICATE
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Name | DR. JOHN M EVERINGHAM
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Credential | D.C.
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Telephone | 309-663-8388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 060002911- 038007235
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License Number State | IL
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