MEDICARE: VINCENT CHIROPRACTIC, S.C.

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	038012645	IL

General Provider Information

NPI Number	:	1982069894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINCENT CHIROPRACTIC, S.C.

Provider Business Mailing Address
First Line	:	120 S DELMAR AVE
Second Line	:	SUITE B P.O. BOX 458
City	:	SALEM
State	:	IL
Zip	:	62881-2000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 S DELMAR AVE
Second Line	:	SUITE B
City	:	SALEM
State	:	IL
Zip	:	62881-2000
Country	:	US
Telephone Number	:	618-740-1711
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KYLEIGH VINCENT
Credential	:	D.C.
Telephone Number	:	618-740-1711

Provider Enumeration Date	:	12/18/2015
Last Update Date	:	12/18/2015

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Directions to “VINCENT CHIROPRACTIC, S.C. ” Practice Location

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