Provider Demographics
NPI:1730326711
Name:STORCK, CHAD E (DC)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:E
Last Name:STORCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 N 2550 ST
Mailing Address - Street 2:
Mailing Address - City:FARINA
Mailing Address - State:IL
Mailing Address - Zip Code:62838-2012
Mailing Address - Country:US
Mailing Address - Phone:618-444-4010
Mailing Address - Fax:
Practice Address - Street 1:370 WEST ORCHARD STREET
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-2821
Practice Address - Country:US
Practice Address - Phone:618-444-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009000344111N00000X
IL038.011327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor