Provider Demographics
NPI:1194921080
Name:SHERMAN CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SHERMAN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FOLKERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-496-3636
Mailing Address - Street 1:PO BOX 380
Mailing Address - Street 2:420 SOUTH CROSSING DRIVE
Mailing Address - City:SHERMAN
Mailing Address - State:IL
Mailing Address - Zip Code:62684-0380
Mailing Address - Country:US
Mailing Address - Phone:217-496-3636
Mailing Address - Fax:217-496-3838
Practice Address - Street 1:420 S CROSSING RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:IL
Practice Address - Zip Code:62684-9640
Practice Address - Country:US
Practice Address - Phone:217-496-3636
Practice Address - Fax:217-496-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038008204Medicaid
IL08408756OtherBLUE CROSS PROVIDER ID
IL=========OtherTAX ID
IL=========OtherTAX ID
ILU66728Medicare UPIN