Provider Demographics
NPI:1972030971
Name:ESSENTIAL CHIROPRACTIC CLINIC, LLC
Entity type:Organization
Organization Name:ESSENTIAL CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:YUNCHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANG-HUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-271-9944
Mailing Address - Street 1:918 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-2138
Mailing Address - Country:US
Mailing Address - Phone:563-271-9944
Mailing Address - Fax:
Practice Address - Street 1:918 15TH AVE
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-2138
Practice Address - Country:US
Practice Address - Phone:309-623-4324
Practice Address - Fax:309-644-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty