Provider Demographics
NPI:1356746861
Name:MURPHY CHIROPRACTIC AND WELLNESS CORP
Entity type:Organization
Organization Name:MURPHY CHIROPRACTIC AND WELLNESS CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:MURPHY-MRAVLE
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF CHIROPRACT
Authorized Official - Phone:815-230-3776
Mailing Address - Street 1:13550 RTE 30, LL 104
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544
Mailing Address - Country:US
Mailing Address - Phone:815-230-3776
Mailing Address - Fax:815-664-3307
Practice Address - Street 1:13550 RTE 30
Practice Address - Street 2:LL 104
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544
Practice Address - Country:US
Practice Address - Phone:815-230-3776
Practice Address - Fax:815-664-3307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5195Medicare UPIN
ILIL5195Medicare UPIN