Provider Demographics
NPI:1902106859
Name:DUNPHY WELLNESS CENTER
Entity Type:Organization
Organization Name:DUNPHY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DUNPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-528-9771
Mailing Address - Street 1:2745 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-4071
Mailing Address - Country:US
Mailing Address - Phone:217-528-9771
Mailing Address - Fax:217-528-9777
Practice Address - Street 1:2745 S 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-4071
Practice Address - Country:US
Practice Address - Phone:217-528-9771
Practice Address - Fax:217-528-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty