Provider Demographics
NPI:1700104064
Name:MIDWEST CHIROPRACTIC CENTER P.C.
Entity type:Organization
Organization Name:MIDWEST CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HANKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-829-1010
Mailing Address - Street 1:1210 TOWANDA AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3454
Mailing Address - Country:US
Mailing Address - Phone:309-829-1010
Mailing Address - Fax:309-829-0142
Practice Address - Street 1:1210 TOWANDA AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3454
Practice Address - Country:US
Practice Address - Phone:309-829-1010
Practice Address - Fax:309-829-0142
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST CHIROPRACTIC CENTER P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003573302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization