Provider Demographics
NPI:1427237239
Name:ADAMS CHIROPRACTIC CLINIC, PC
Entity type:Organization
Organization Name:ADAMS CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:REATHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-367-4183
Mailing Address - Street 1:215 W MT VERNON
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:IL
Mailing Address - Zip Code:61548
Mailing Address - Country:US
Mailing Address - Phone:309-367-4183
Mailing Address - Fax:
Practice Address - Street 1:215 W MT VERNON
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:IL
Practice Address - Zip Code:61548
Practice Address - Country:US
Practice Address - Phone:309-367-4183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10282006OtherBLUE CROSS BLUE SHIELD
IL521640Medicare PIN