Provider Demographics
NPI:1548282940
Name:VANCE, TOMMY J (DC)
Entity type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:J
Last Name:VANCE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-6722
Mailing Address - Country:US
Mailing Address - Phone:217-228-9000
Mailing Address - Fax:217-228-9001
Practice Address - Street 1:1420 S 14TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-6722
Practice Address - Country:US
Practice Address - Phone:217-228-9000
Practice Address - Fax:217-228-9001
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT43226Medicare UPIN