| Southern Illinois Spine & Joint Center Of Marissa Llc | |
|
112 N Main St, Marissa, IL 62257-1365 | |
| (618) 295-2268 | |
| (618) 295-3521 |
| Full Name | Southern Illinois Spine & Joint Center Of Marissa Llc |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 112 N Main St, Marissa, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053664557 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | 038011854 (Illinois) | Primary |
| Provider Name | Dillon L Kaesberg |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1821392952 PECOS PAC ID: 0547443962 Enrollment ID: I20110323000185 |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Illinois Spine & Joint Center Of Marissa Llc 112 N Main St, Marissa, IL 62257-1365 Ph: (618) 295-2268 | Southern Illinois Spine & Joint Center Of Marissa Llc 112 N Main St, Marissa, IL 62257-1365 Ph: (618) 295-2268 |
Dr. Gary Lane Benedict, D.C. Chiropractor Medicare: Not Enrolled in Medicare Practice Location: 112 N Main St, Marissa, IL 62257 Phone: 618-295-2268 | |
Southern Illinois Spine & Joint Center Chiropractor Medicare: Not Enrolled in Medicare Practice Location: 112 N Main St, Marissa, IL 62257 Phone: 618-295-2268 | |
Dr. Dillon Lee Kaesberg, D.C. Chiropractor Medicare: Accepting Medicare Assignments Practice Location: 112 N Main St, Marissa, IL 62257 Phone: 618-295-2268 Fax: 618-295-3521 |