MEDICARE: DR. JOSEPH C PROBST DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	038008186	IL

General Provider Information

NPI Number	:	1265558837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH C PROBST DC

Provider Business Mailing Address
First Line	:	1407 PATE PLAZA DR
Second Line	:
City	:	SOUTH BELOIT
State	:	IL
Zip	:	61080-1431
Country	:	US
Telephone Number	:	815-389-7870
Fax Number	:	815-389-7870

Provider Business Practice Location Address
First Line	:	1407 PATE PLAZA DR
Second Line	:
City	:	SOUTH BELOIT
State	:	IL
Zip	:	61080-1431
Country	:	US
Telephone Number	:	815-389-7870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	08/06/2018

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Directions to “ DR. JOSEPH C PROBST DC” Practice Location

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