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General NPI Number Information
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NPI Number | 1508302985
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Entity Type | Organization
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Legal Business Name | STASSI CHIROPRACTIC & WELLNESS CENTER LLC
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 112 W BETHALTO BLVD
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City | BETHALTO
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State | IL
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Zip | 62010-1703
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Country | US
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Telephone | 618-717-0621
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Fax | 618-717-0622
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Provider Business Mailing Address
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Address Line | 112 W BETHALTO BLVD
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City | BETHALTO
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State | IL
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Zip | 62010-1703
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Country | US
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Telephone | 618-717-0621
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Fax | 618-717-0622
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Authorized Official
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Title or Position | OWNER
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Name | DR. KORY J STASSI
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Credential | D.C.
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Telephone | 618-717-0621
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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 | 038012925
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License Number State | IL
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