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General NPI Number Information
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NPI Number | 1629478672
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Entity Type | Organization
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Legal Business Name | CENTRAL IL CHIROPRACTIC, LTD
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Dates
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Enumeration Date | 08/27/2014
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 1030 COURT ST
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City | PEKIN
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State | IL
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Zip | 61554-4806
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Country | US
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Telephone | 309-346-8008
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Fax | 309-346-8009
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Provider Business Mailing Address
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Address Line | 1030 COURT ST
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City | PEKIN
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State | IL
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Zip | 61554-4806
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Country | US
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Telephone | 309-346-8008
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Fax | 309-346-8009
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Authorized Official
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Title or Position | PRESIDENT/CHIROPRACTOR
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Name | DR. JACOB ALLEN DUNKER
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Credential | D.C.
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Telephone | 309-346-8008
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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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