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General NPI Number Information
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NPI Number | 1881727642
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Entity Type | Organization
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Legal Business Name | SPRINGFIELD CHIROPRACTIC CLINIC LTD
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 04/16/2012
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Provider Practice Location Address
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Address Line | 1045 S 2ND ST
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City | SPRINGFIELD
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State | IL
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Zip | 62704-3004
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Country | US
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Telephone | 217-544-5213
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Fax | 217-544-8792
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Provider Business Mailing Address
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Address Line | 1045 S 2ND ST
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City | SPRINGFIELD
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State | IL
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Zip | 62704-3004
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Country | US
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Telephone | 217-544-5213
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Fax | 217-544-8792
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. TIMOTHY L WENNEBORG
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Credential | D.C.
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Telephone | 217-544-5213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 042007918
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License Number State | IL
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