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General NPI Number Information
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NPI Number | 1487950721
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Entity Type | Organization
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Legal Business Name | CORRECTIVE CHIROPRACTIC HEALTH CENTER INC
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Dates
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Enumeration Date | 02/03/2011
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 2500 KENNEDY DR
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City | EAST MOLINE
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State | IL
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Zip | 61244-2619
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Country | US
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Telephone | 309-755-9515
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Fax | 309-755-9521
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Provider Business Mailing Address
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Address Line | 2500 KENNEDY DR
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City | EAST MOLINE
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State | IL
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Zip | 61244-2619
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Country | US
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Telephone | 309-755-9515
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Fax | 309-755-9521
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Authorized Official
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Title or Position | PRESIDENT
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Name | JERRY RUPLINGER
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Credential |
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Telephone | 309-755-9515
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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 | 038007559
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License Number State | IL
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