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General NPI Number Information
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NPI Number | 1720571532
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Entity Type | Organization
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Legal Business Name | PRIDE IN YOUR HEALTH PC
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 1804 N LINCOLN AVE
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City | URBANA
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State | IL
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Zip | 61801-1023
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Country | US
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Telephone | 217-281-3551
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Fax |
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Provider Business Mailing Address
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Address Line | 1804 N LINCOLN AVE
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City | URBANA
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State | IL
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Zip | 61801-1023
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | J. CASEY PRIDE
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Credential | DC
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Telephone | 217-281-3551
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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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