1205826302 NPI number — SCHIPPEL CHIROPRACTIC SC

Table of content: MS. HYACINTH GRETCHEN HOEY RN (NPI 1982841292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205826302 NPI number — SCHIPPEL CHIROPRACTIC SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHIPPEL CHIROPRACTIC SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205826302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1429 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-245-9797
Provider Business Mailing Address Fax Number:
217-245-2524

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1429 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-245-9797
Provider Business Practice Location Address Fax Number:
217-245-2524
Provider Enumeration Date:
10/28/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHIPPEL
Authorized Official First Name:
KARL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
217-245-9797

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 06922750 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1194855 . This is a "FIRST HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 391375 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 045216 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".