Provider Demographics
NPI:1285785808
Name:CARMI CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:CARMI CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:H
Authorized Official - Last Name:AHLERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-384-2631
Mailing Address - Street 1:1624 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-2235
Mailing Address - Country:US
Mailing Address - Phone:618-384-2631
Mailing Address - Fax:618-384-2908
Practice Address - Street 1:1624 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-2235
Practice Address - Country:US
Practice Address - Phone:618-384-2631
Practice Address - Fax:618-384-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09732001OtherBLUECROSS AND BLUESHIELD
IL09732001OtherBLUECROSS AND BLUESHIELD