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General NPI Number Information
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NPI Number | 1538295266
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Entity Type | Organization
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Legal Business Name | PECATONICA CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 427 N MAIN ST
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City | PECATONICA
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State | IL
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Zip | 61063-9384
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Country | US
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Telephone | 815-239-1121
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Fax | 815-239-2766
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Provider Business Mailing Address
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Address Line | 427 MAIN STREET
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City | PECATONICA
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State | IL
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Zip | 61063-9384
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Country | US
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Telephone | 815-239-1121
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Fax | 815-239-2766
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | JEFFREY P GEHLSEN
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Credential | D.C.
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Telephone | 815-239-1121
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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 | 038-009349
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License Number State | IL
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