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General NPI Number Information
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NPI Number | 1740454065
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Entity Type | Organization
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Legal Business Name | DR DAN KHAMPRASEUT
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 3620A N BELT W
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City | BELLEVILLE
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State | IL
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Zip | 62226-5947
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Country | US
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Telephone | 618-233-3324
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Fax | 618-233-4758
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Provider Business Mailing Address
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Address Line | 3620A N BELT W
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City | BELLEVILLE
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State | IL
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Zip | 62226-5947
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Country | US
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Telephone | 618-233-3324
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Fax | 618-233-4758
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DAN KHAMPRASEUT
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Credential | DC
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Telephone | 618-233-3324
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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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