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General NPI Number Information
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NPI Number | 1568355089
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Entity Type | Organization
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Legal Business Name | STRONG ROOTS CHIROPRACTIC LLC
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 1932 S MAIN ST
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City | EUREKA
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State | IL
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Zip | 61530-1666
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Country | US
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Telephone | 309-467-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1932 S MAIN ST
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City | EUREKA
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State | IL
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Zip | 61530-1666
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Country | US
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Telephone | 309-467-5000
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | SAMUEL HENDRICKS
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Credential | DC
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Telephone | 309-258-0283
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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 |
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License Number State |
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