Provider Demographics
NPI:1194595603
Name:SHAUGHNESSY REID DC LLC
Entity type:Organization
Organization Name:SHAUGHNESSY REID DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUGHNESSY
Authorized Official - Middle Name:R
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-725-6976
Mailing Address - Street 1:2049 S BATES AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3304
Mailing Address - Country:US
Mailing Address - Phone:217-725-6976
Mailing Address - Fax:217-698-4863
Practice Address - Street 1:2920 CHATHAM RD STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7004
Practice Address - Country:US
Practice Address - Phone:217-698-5800
Practice Address - Fax:214-698-4863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty