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General NPI Number Information
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NPI Number | 1619236221
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Entity Type | Organization
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Legal Business Name | KNOX COUNTY CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 2522 E LINCOLNWAY STE G
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City | STERLING
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State | IL
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Zip | 61081-3058
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Country | US
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Telephone | 815-866-5029
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Fax | 309-342-9147
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Provider Business Mailing Address
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Address Line | 2522 E LINCOLNWAY STE G
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City | STERLING
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State | IL
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Zip | 61081-3058
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Country | US
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Telephone | 815-866-5029
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Fax | 309-342-9147
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | BRADLEY J SETCHELL
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Credential | D.C.
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Telephone | 815-866-5029
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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 | 038-011042
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License Number State | IL
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