MEDICARE: CHARLESTON CHIROPRACTIC CENTER LLC

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

General Provider Information

NPI Number	:	1750184743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLESTON CHIROPRACTIC CENTER LLC

Provider Business Mailing Address
First Line	:	710 JACKSON AVE
Second Line	:
City	:	CHARLESTON
State	:	IL
Zip	:	61920-2004
Country	:	US
Telephone Number	:	217-549-0902
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 JACKSON AVE
Second Line	:
City	:	CHARLESTON
State	:	IL
Zip	:	61920-2004
Country	:	US
Telephone Number	:	217-549-0902
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	KALEB BROWN
Credential	:	DC
Telephone Number	:	217-549-0902

Provider Enumeration Date	:	03/27/2025
Last Update Date	:	03/27/2025

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