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General NPI Number Information
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NPI Number | 1730391269
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Entity Type | Organization
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Legal Business Name | DOWNSTATE CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1002 COMMERCIAL DRIVE SUITE 4
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City | MAHOMET
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State | IL
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Zip | 61853
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Country | US
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Telephone | 217-586-7535
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Fax |
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Provider Business Mailing Address
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Address Line | 214 NORTH LADD STREET
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City | PONTIAC
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State | IL
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Zip | 61764
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Country | US
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Telephone | 815-844-4631
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIMBERLY K KIDNER
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Credential | D.C.
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Telephone | 815-844-4631
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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 | IL
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