Provider Demographics
NPI:1932389202
Name:MOLINE CHIROPRACTIC CLINIC, PC
Entity type:Organization
Organization Name:MOLINE CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:VANA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-764-4753
Mailing Address - Street 1:4300 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-2511
Mailing Address - Country:US
Mailing Address - Phone:309-764-4753
Mailing Address - Fax:309-764-8753
Practice Address - Street 1:4300 12TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-2511
Practice Address - Country:US
Practice Address - Phone:309-764-4753
Practice Address - Fax:309-764-8753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty