Provider Demographics
NPI:1063885895
Name:RICHIE CHIROPRACTIC HEALTH CENTRE
Entity type:Organization
Organization Name:RICHIE CHIROPRACTIC HEALTH CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:W
Authorized Official - Last Name:RICHIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-698-2779
Mailing Address - Street 1:2205 WABASH AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-5354
Mailing Address - Country:US
Mailing Address - Phone:217-698-2779
Mailing Address - Fax:217-698-7507
Practice Address - Street 1:2205 WABASH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-5354
Practice Address - Country:US
Practice Address - Phone:217-698-2779
Practice Address - Fax:217-698-7507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.008580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty