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General NPI Number Information
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NPI Number | 1952273914
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Entity Type | Organization
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Legal Business Name | RADIANT CHIROPRACTIC AND NATURAL HEALTH LLC
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 105 N WASHINGTON ST
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City | JERSEYVILLE
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State | IL
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Zip | 62052-1633
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Country | US
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Telephone | 618-556-1062
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Fax |
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Provider Business Mailing Address
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Address Line | 105 N WASHINGTON ST
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City | JERSEYVILLE
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State | IL
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Zip | 62052-1633
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Country | US
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Telephone | 618-556-1062
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | SAMANTHA STACKPOLE
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Credential | DC
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Telephone | 618-556-1062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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