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General NPI Number Information
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NPI Number | 1730361288
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Entity Type | Organization
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Legal Business Name | SCOTT COUNTY CHIROPRACTIC, LTD.
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 38 E CHERRY ST
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City | WINCHESTER
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State | IL
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Zip | 62694-1002
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Country | US
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Telephone | 217-742-5702
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Fax | 217-742-5661
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Provider Business Mailing Address
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Address Line | 38 E CHERRY ST
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City | WINCHESTER
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State | IL
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Zip | 62694-1002
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Country | US
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Telephone | 217-742-5702
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Fax | 217-742-5661
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Authorized Official
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Title or Position | DOCTOR/PRESIDENT
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Name | DR. GARY J T GARCIA
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Credential | DC
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Telephone | 217-742-5702
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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 | 038-010006
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License Number State | IL
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