SOUTHERN ILLINOIS CHIROPRACTIC CENTER (NPI# 1407991771) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407991771 |
| Entity Type | Organization |
| Organization Name | SOUTHERN ILLINOIS CHIROPRACTIC CENTER |
| Practice Address |
2 Professional Park Drive Suite B Maryville IL 62062-5746 |
| Practice Telephone | 6182887991 |
| Practice Fax Number | 6182887901 |
| Mailing Telephone | 6182887991 |
| Mailing Fax Number | 6182887901 |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. BARRY T DELASSUS (OWNER CHIROPRACTOR) |
| Authorized Official Telephone | 6182887991 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | IL | Chiropractic Providers |
| Street Address |
2 PROFESSIONAL PARK DRIVE SUITE B |
| City | MARYVILLE |
| State | IL |
| Zip Code | 62062-5746 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104325091 | Jennifer M Oyler | Physician Assistant | 6812 State Route 162 Suite 120, Maryville, IL 62062 | 2018-02-06 |
| 1710495965 | Sarah Elizabeth Barto | Family Medicine | 2133 Vadalabene Drive, Suite Sb, Maryville, IL 62062 | 2018-01-22 |
| 1104348085 | Lindsey Nicole Langendorf | Chiropractor | 62 Executive Plaza Ct, Maryville, IL 62062 | 2017-07-12 |
| 1043750540 | Gina Saal | Nurse Anesthetist, Certified Registered | 6800 Rt 162, Maryville, IL 62062 | 2017-03-02 |
| 1548657737 | Karen Michelle Bertels | Emergency Medicine | 6800 Il - 162, Maryville, IL 62062 | 2015-04-25 |
| 1811258148 | Debra Ann Hoelscher | Internal Medicine | 2102 Vadalabene, Maryville, IL 62062 | 2012-06-04 |
| 1538438445 | Casey Elizabeth Wiesemeyer | Speech-Language Pathologist | 2201 Copper Creek Rd, Maryville, IL 62062 | 2011-12-21 |
| 1407144819 | Norah Claire Farley Baker | Family Medicine | 10 Professional Park Dr., Maryville, IL 62062 | 2011-07-19 |
| 1891092474 | Kimberly M Schneider | Physician Assistant | 20b Professional Park Drive, Maryville, IL 62062 | 2011-02-17 |
| 1669782397 | Purandhri Patel | Physical Therapist | 6820 State Route 162, Maryville, IL 62062 | 2010-10-15 |
| Find all providers in zip 62062 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649799966 | Carolyn Rose Filla | Chiropractor | 1780 W Lamar Alexander Pkwy, Maryville, TN 37801-3784 | 2017-09-19 |
| 1104348085 | Lindsey Nicole Langendorf | Chiropractor | 62 Executive Plaza Ct, Maryville, IL 62062 | 2017-07-12 |
| 1457684219 | Bryan W Reid | Chiropractor | 2805 N Center St, Maryville, IL 62062-5622 | 2009-09-11 |
| 1154569150 | Catherine R Flynn | Chiropractor | 802 Mountain View Ave, Maryville, TN 37803-4822 | 2009-01-29 |
| 1659563542 | Walsh Chiropractic Ltd | Chiropractor | 2800 N Center, Maryville, IL 62062 | 2007-08-14 |
| 1053523811 | Steven R Watts | Chiropractor | 1011 W Broadway Ave, Maryville, TN 37801-4638 | 2007-05-04 |
| 1558586727 | Olav E. Lipiec | Chiropractor | 26044 Lakeview Dr, Maryville, MO 64468-7263 | 2007-04-14 |
| 1801931142 | Evan William Butcher | Chiropractor | 2724 E Broadway Ave, Maryville, TN 37804-2557 | 2007-02-21 |
| 1801943113 | Bryan R Ardis | Chiropractor | 1103 E Lamar Alexander Pkwy, Maryville, TN 37804-5130 | 2007-01-05 |
| 1104997626 | Joseph Scott Marsh | Chiropractor | 424 Home Ave, Maryville, TN 37801-3915 | 2006-11-13 |
| Find all providers in MARYVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.