Provider Demographics
NPI:1154432193
Name:PAGE FAMILY CHIROPRACTIC CLINIC INC
Entity type:Organization
Organization Name:PAGE FAMILY CHIROPRACTIC CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:217-446-7200
Mailing Address - Street 1:2700 N JACKSON
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832
Mailing Address - Country:US
Mailing Address - Phone:217-446-7200
Mailing Address - Fax:217-446-0090
Practice Address - Street 1:2700 N JACKSON
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832
Practice Address - Country:US
Practice Address - Phone:217-446-7200
Practice Address - Fax:217-446-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005681111N00000X
IL038009157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
010248OtherHEALTH ALLIANCE DR PAGE
9215163OtherBLUE CROSS BLUE SHIELD
177908OtherPERSONAL CARE DR PAGE
177910OtherPERSONAL CARE DR RITCHIE
063656OtherHLTH ALLIANCE DR RITCHIE
622220Medicare ID - Type UnspecifiedDR SCOTT RITCHIE
177908OtherPERSONAL CARE DR PAGE
010248OtherHEALTH ALLIANCE DR PAGE
U82998Medicare UPIN