Provider Demographics
NPI:1588929277
Name:RIVER CITY ALTERNATIVE HEALTH, INC.
Entity type:Organization
Organization Name:RIVER CITY ALTERNATIVE HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-848-9017
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:PORT BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61275-0097
Mailing Address - Country:US
Mailing Address - Phone:309-848-9017
Mailing Address - Fax:888-830-9748
Practice Address - Street 1:106 N HIGH ST
Practice Address - Street 2:
Practice Address - City:PORT BYRON
Practice Address - State:IL
Practice Address - Zip Code:61275-9532
Practice Address - Country:US
Practice Address - Phone:309-848-9017
Practice Address - Fax:888-830-9748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty