Provider Demographics
NPI:1699895201
Name:CONROD CHIROPRACTIC CLINIC LTD.
Entity type:Organization
Organization Name:CONROD CHIROPRACTIC CLINIC LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CONROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-941-2225
Mailing Address - Street 1:1802 DIVISION ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1182
Mailing Address - Country:US
Mailing Address - Phone:815-941-2225
Mailing Address - Fax:815-941-2785
Practice Address - Street 1:1802 DIVISION ST
Practice Address - Street 2:SUITE 211
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1182
Practice Address - Country:US
Practice Address - Phone:815-941-2225
Practice Address - Fax:815-941-2785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205321Medicare PIN
ILT39190Medicare UPIN