Provider Demographics
NPI:1306811336
Name:CAPITOL CHIROMED, LTD.
Entity type:Organization
Organization Name:CAPITOL CHIROMED, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-391-5446
Mailing Address - Street 1:3631 S 6TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-4777
Mailing Address - Country:US
Mailing Address - Phone:217-391-5446
Mailing Address - Fax:217-585-6720
Practice Address - Street 1:3631 S 6TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-4777
Practice Address - Country:US
Practice Address - Phone:217-391-5446
Practice Address - Fax:217-585-6720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08423460OtherBLUE CROSS BLUE SHIELD #
IL569590Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER