PAIN RELIEF CENTER OF VANDALIA INC (NPI# 1588773089) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588773089 |
| Entity Type | Organization |
| Organization Name | PAIN RELIEF CENTER OF VANDALIA INC |
| Practice Address |
100 N Kennedy Blvd Vandalia IL 62471 |
| Practice Telephone | 6182831100 |
| Practice Fax Number | 6182831101 |
| Mailing Telephone | 6182831100 |
| Mailing Fax Number | 6182831101 |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2015-06-19 |
| Authorized Official Name | DR. JEREMY RYAN CLARK (DOCTOR OF CHIROPRACTIC) |
| Authorized Official Telephone | 6182831100 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 038009768 | IL | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS | 02632010 | 01 |
| IL | HL | 539980 | 01 |
| Street Address |
100 N KENNEDY BLVD |
| City | VANDALIA |
| State | IL |
| Zip Code | 62471 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710018395 | Jeremy R Clark | Chiropractor | 100 N Kennedy Blvd, Vandalia, IL 62471-2314 | 2007-03-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083924740 | Micah Brasel | Optometrist | 300 W Randolph, Vandalia, IL 62471 | 2010-10-15 |
| 1154635332 | Marion Eye Centers Ltd. | Durable Medical Equipment & Medical Supplies | 300 West Randolph, Vandalia, IL 62471 | 2010-07-30 |
| 1972771699 | Community Resource Center | Community Based Residential Treatment Facility, Mental Illness | 423 W Main, Vandalia, IL 62471 | 2008-02-15 |
| 1952429078 | Julie M Gordon | Physical Therapist | 126 S. First Street, Vandalia, IL 62471 | 2007-03-27 |
| 1033200183 | Penny Attaway | Nurse Practitioner | 1404 N 5th Street, Vandalia, IL 62471 | 2006-09-27 |
| 1811003551 | Fayco Enterprises Inc | Day Training, Developmentally Disabled Services | 1313 Sunset Drive, Vandalia, IL 62471 | 2006-08-23 |
| 1174585384 | Vandalia Physical Therapy Ltd | Physical Therapist | 126 S. 1st St., Vandalia, IL 62471 | 2006-04-04 |
| 1548221799 | Arkom Chulamorkodt | Family Medicine | 606 W Jackson St, Vandalia, IL 62471 | 2006-03-29 |
| 1568581163 | Ashley Hadowsky | Physical Therapist | 126 S. First Street, Vandalia, IL 62471 | 2007-03-28 |
| 1497868772 | Fayette County Hospital District | Skilled Nursing Facility | 650 W Taylor St, Vandalia, IL 62471 | 2006-08-17 |
| Find all providers in zip 62471 | ||||
| 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 |
|---|---|---|---|---|
| 1134298953 | Jeffrey James Brockert | Chiropractor | 347 South Dixie Dr, Vandalia, OH 45377 | 2006-11-07 |
| 1942307988 | Heather Kay Foley | Chiropractor | 427 W Orchard St Ste B, Vandalia, IL 62471-1256 | 2006-09-20 |
| 1720091150 | Joseph J Solan | Chiropractor | 427 W Orchard St, Ste B, Vandalia, IL 62471-1256 | 2006-08-15 |
| 1376554485 | Michael Robert Cole | Chiropractor | 201 S. Main St., Vandalia, MO 63382-0149 | 2006-08-11 |
| 1699702589 | Matthew Earl Labertew | Chiropractor | 825 New York Dr Ste 1, Vandalia, IL 62471-1044 | 2006-06-27 |
| 1538121702 | Todd A Heitkamp | Chiropractor | 19 S Perry St, Vandalia, OH 45377-2120 | 2006-04-04 |
| 1730326711 | Chad E Storck | Chiropractor | 312 W Gallatin St, Vandalia, IL 62471-2821 | 2009-01-13 |
| 1629223425 | Cole Chiropractic Center LLC | Chiropractor | 201 S. Main St., Vandalia, MO 63382-0149 | 2008-11-20 |
| 1487778924 | Tepperberg Chiropractic Center | Chiropractor | 110 S 6th St, Vandalia, IL 62471-2737 | 2007-03-19 |
| 1114059227 | J Cox Enterprises Ltd | Chiropractor | 825 New York Dr Ste 1, Vandalia, IL 62471-1044 | 2007-03-12 |
| Find all providers in VANDALIA | ||||
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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.