Provider Demographics
NPI:1386723898
Name:PATHWAY CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:PATHWAY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LANDREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-625-2400
Mailing Address - Street 1:707 CARROLL ST.
Mailing Address - Street 2:SUITE C
Mailing Address - City:PAWNEE
Mailing Address - State:IL
Mailing Address - Zip Code:62558
Mailing Address - Country:US
Mailing Address - Phone:217-625-2400
Mailing Address - Fax:217-625-2406
Practice Address - Street 1:707 CARROLL ST.
Practice Address - Street 2:SUITE C
Practice Address - City:PAWNEE
Practice Address - State:IL
Practice Address - Zip Code:62558
Practice Address - Country:US
Practice Address - Phone:217-625-2400
Practice Address - Fax:217-625-2406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU84643Medicare UPIN