MEDICARE: DUNPHY WELLNESS CENTER

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	038011337	IL

General Provider Information

NPI Number	:	1902106859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUNPHY WELLNESS CENTER

Provider Business Mailing Address
First Line	:	2745 S 6TH ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-4071
Country	:	US
Telephone Number	:	217-528-9771
Fax Number	:	217-528-9777

Provider Business Practice Location Address
First Line	:	2745 S 6TH ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-4071
Country	:	US
Telephone Number	:	217-528-9771
Fax Number	:	217-528-9777

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN LEE DUNPHY
Credential	:	DC
Telephone Number	:	217-528-9771

Provider Enumeration Date	:	10/26/2010
Last Update Date	:	03/23/2011

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