| Healthsource Chiropractic Of Champaign, S.c. | |
|
2003 Round Barn Rd Suite B Champaign IL 61821-6827 | |
| (217) 281-0006 | |
| Not Available |
| Full Name | Healthsource Chiropractic Of Champaign, S.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 2003 Round Barn Rd, Champaign, Illinois |
| Authorized Official Name and Position | Cameron Robert Mackichan (OWNER) |
| Authorized Official Contact | 2172810006 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthsource Chiropractic Of Champaign, S.c. 2003 Round Barn Rd Suite B Champaign IL 61821-6827 Ph: (217) 281-0006 | Healthsource Chiropractic Of Champaign, S.c. 2003 Round Barn Rd Suite B Champaign IL 61821-6827 Ph: (217) 281-0006 |
| NPI Number | 1023556164 |
|---|---|
| Provider Enumeration Date | 02/09/2017 |
| Last Update Date | 01/16/2018 |
| Medicare PECOS PAC ID | 1850650896 |
|---|---|
| Medicare Enrollment ID | O20180119000153 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023556164 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 038.012800 (Illinois) | Primary |
| Provider Name | Cameron R Mackichan |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1487008272 PECOS PAC ID: 4486913423 Enrollment ID: I20180119000282 |
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