| Johnson Family Chiropractic Of Peoria, Pc | |
|
3227 N Prospect Rd Peoria IL 61603-1544 | |
| (309) 688-8773 | |
| Not Available |
| Full Name | Johnson Family Chiropractic Of Peoria, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3227 N Prospect Rd, Peoria, Illinois |
| Authorized Official Name and Position | Kyle Johnson (PRESIDENT) |
| Authorized Official Contact | 3096888773 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Johnson Family Chiropractic Of Peoria, Pc 3227 N Prospect Rd Peoria IL 61603-1544 Ph: (309) 688-8773 | Johnson Family Chiropractic Of Peoria, Pc 3227 N Prospect Rd Peoria IL 61603-1544 Ph: (309) 688-8773 |
| NPI Number | 1508167388 |
|---|---|
| Provider Enumeration Date | 11/09/2010 |
| Last Update Date | 11/09/2010 |
| Medicare PECOS PAC ID | 8426247594 |
|---|---|
| Medicare Enrollment ID | O20110105001198 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508167388 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 038011802 (Illinois) | Primary |
| Provider Name | Kyle Patrick Johnson |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1790086577 PECOS PAC ID: 9335338409 Enrollment ID: I20110105001236 |
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