Provider Demographics
NPI:1629478672
Name:CENTRAL IL CHIROPRACTIC, LTD
Entity type:Organization
Organization Name:CENTRAL IL CHIROPRACTIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-346-8008
Mailing Address - Street 1:1030 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-4806
Mailing Address - Country:US
Mailing Address - Phone:309-346-8008
Mailing Address - Fax:309-346-8009
Practice Address - Street 1:1030 COURT ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-4806
Practice Address - Country:US
Practice Address - Phone:309-346-8008
Practice Address - Fax:309-346-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty