Provider Demographics
NPI:1992913719
Name:HIGH CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:HIGH CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:HIGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-833-7014
Mailing Address - Street 1:12329 PEBBLE POINT RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-8530
Mailing Address - Country:US
Mailing Address - Phone:618-995-2201
Mailing Address - Fax:
Practice Address - Street 1:35 WALTON LANE
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906
Practice Address - Country:US
Practice Address - Phone:618-833-7014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty