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General NPI Number Information
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NPI Number | 1518152669
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Entity Type | Organization
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Legal Business Name | INFINITE WELLNESS CHIROPRACTIC, LTD.
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 220 EVERGREEN LANE UNIT B
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City | GLEN CARBON
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State | IL
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Zip | 62034-6203
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Country | US
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Telephone | 618-655-0333
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Fax |
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Provider Business Mailing Address
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Address Line | 28 MEADOW RUE DR
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3141
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Country | US
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Telephone | 618-980-3150
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RYAN J CLELAND
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Credential | D.C
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Telephone | 618-655-0333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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