=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942003934
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AN APPLE A DAY HEALTH CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2025
-----------------------------------------------------
Last Update Date | 03/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 N MAIN ST
-----------------------------------------------------
City | NIANTIC
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62551-4238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-872-5452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 77 MCLEOD AVE
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61920-2951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | KALEB BROWN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 217-872-5452
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------