Provider Demographics
NPI:1326191685
Name:A & M CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:A & M CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-632-7246
Mailing Address - Street 1:3930 GREEN MOUNT CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7289
Mailing Address - Country:US
Mailing Address - Phone:618-632-7246
Mailing Address - Fax:618-632-4540
Practice Address - Street 1:3930 GREEN MOUNT CROSSING DR
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-7289
Practice Address - Country:US
Practice Address - Phone:618-632-7246
Practice Address - Fax:618-632-4540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8232106OtherBLUECROSSBLUESHIELD
ILPENDINGMedicare ID - Type Unspecified