Provider Demographics
NPI:1215100227
Name:CHIROPRACTICWORKSLLC
Entity type:Organization
Organization Name:CHIROPRACTICWORKSLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCCLUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-343-3602
Mailing Address - Street 1:410 REGENCY CTR
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4659
Mailing Address - Country:US
Mailing Address - Phone:618-343-3602
Mailing Address - Fax:
Practice Address - Street 1:410 REGENCY CTR
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4659
Practice Address - Country:US
Practice Address - Phone:618-343-3602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06032272OtherBCBS
IL216412Medicare PIN