Provider Demographics
NPI:1548645567
Name:ANDERSEN CHIROPRACTIC HEALTH, S.C.
Entity type:Organization
Organization Name:ANDERSEN CHIROPRACTIC HEALTH, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:217-351-1980
Mailing Address - Street 1:606 N COUNTRY FAIR DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-2496
Mailing Address - Country:US
Mailing Address - Phone:217-351-1980
Mailing Address - Fax:217-351-4070
Practice Address - Street 1:606 N COUNTRY FAIR DR
Practice Address - Street 2:SUITE B
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-2496
Practice Address - Country:US
Practice Address - Phone:217-351-1980
Practice Address - Fax:217-351-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty