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General NPI Number Information
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NPI Number | 1578740452
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Entity Type | Organization
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Legal Business Name | FERRELL CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 09/15/2008
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Provider Practice Location Address
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Address Line | 310 E HIGHWAY 50 SUITE 2
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City | O FALLON
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State | IL
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Zip | 62269-2700
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Country | US
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Telephone | 618-628-4488
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Fax | 618-628-4474
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Provider Business Mailing Address
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Address Line | 310 E HIGHWAY 50 SUITE 2
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City | O FALLON
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State | IL
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Zip | 62269-2700
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Country | US
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Telephone | 618-628-4488
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Fax | 618-628-4474
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | JOSH FERRELL
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Credential | DC
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Telephone | 618-628-4488
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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 | 038010902
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License Number State | IL
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