MEDICARE: SOOLEY CHIROPRACTIC, LTD

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	111N00000X	Chiropractor	038-008299	IL

General Provider Information

NPI Number	:	1689783680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOOLEY CHIROPRACTIC, LTD

Provider Business Mailing Address
First Line	:	11 E FAIRCHILD ST
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-3140
Country	:	US
Telephone Number	:	217-477-7019
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 E FAIRCHILD ST
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-3140
Country	:	US
Telephone Number	:	217-431-3290
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GEORGE RANDALL SOOLEY
Credential	:	DC
Telephone Number	:	217-431-3290

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/24/2023

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