ICAN CLINIC LLC (NPI# 1669722872) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669722872 |
| Entity Type | Organization |
| Organization Name | ICAN CLINIC LLC |
| Other Organization Name | WOOD RIVER CHIROPRACTIC |
| Practice Address |
441 S State Route 157 Ste 2 Edwardsville IL 62025 |
| Mailing Address |
441 S State Route 157 Ste 2 Edwardsville IL 62025-4012 |
| Practice Telephone | 6182542273 |
| Practice Fax Number | 6182548476 |
| Mailing Telephone | 6182542273 |
| Mailing Fax Number | 6182548476 |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2020-10-29 |
| Authorized Official Name | DR. MICHAEL S HARBISON (OWNER/DIRECTOR) |
| Authorized Official Telephone | 6182542273 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 111N00000X | Chiropractor | 038.12178 | IL | Chiropractic Providers |
| N | 111N00000X | Chiropractor | Chiropractic Providers | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Wood River Chiropractic | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 203 E Ferguson Ave, Wood River, IL 620952001 | 6182542273 | 6182548476 |
| Street Address |
441 S STATE ROUTE 157 STE 2 |
| City | EDWARDSVILLE |
| State | IL |
| Zip Code | 62025 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619519535 | Anderson Surgery Center LLC | Clinic/Center | 3403 Anderson Healthcare Drive, Edwardsville, IL 62025 | 2019-10-11 |
| 1194376640 | Katharine Mcginnis D.m.d. P.C. | Dentist | 235 A. South Main St, Edwardsville, IL 62025 | 2019-09-26 |
| 1568925014 | Southern Illinois Pediatric Dentistry of Edwardsville | Dentist | 1419 Lewis Road, Suite 2, Edwardsville, IL 62025 | 2019-04-11 |
| 1902277031 | Amy Lynn Britt | Nurse Practitioner | 1188 South State Route 157, Edwardsville, IL 62025 | 2015-10-15 |
| 1730563230 | Jenna Dallman | Chiropractor | 3 Sunset Hills Professional Center, Suite 2, Edwardsville, IL 62025 | 2015-07-14 |
| 1861745218 | Srimannarayana Marella | Family Medicine | 6616 Center Grove Rd., Edwardsville, IL 62025 | 2012-10-23 |
| 1922371673 | Teresa Marie Garbett | Pharmacist | 2 Sunset Hills Executive Park Dr., Addiction Treatment Strategies, Edwardsville, IL 62025 | 2012-02-10 |
| 1831324342 | Krista Nicole Nelson | Podiatrist | 235 S Main St Ste B, Edwardsville, IL 62025 | 2009-05-28 |
| 1447415757 | Harvey H Breckner D.m.d.,m.s | Exclusive Provider Organization | 600 Country Club View Suite 4, Edwardsville, IL 62025 | 2008-07-25 |
| 1629240569 | Meridian View Family Dental | Dentist | 2133 South Illinois Route 157, Edwardsville, IL 62025 | 2008-04-01 |
| Find all providers in zip 62025 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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| 1558995779 | Signature Medical Clinic LLC | Clinic/Center | 2020 Dean St Ste G, St Charles, IL 60174-1665 | 2020-02-26 |
| 1861024176 | Mount Sinai Community Foundation | Clinic/Center | 1414 S Fairfield, Chicago, IL 60608 | 2020-02-05 |
| 1104460922 | Infinite Care Home Physicians LLC | Clinic/Center | 6044 N Nassau Ave, Chicago, IL 60631-2649 | 2019-11-05 |
| 1962051607 | Wilkes Post Acute Care Inc | Clinic/Center | 400 W 76th St Ste 303, Chicago, IL 60620-1640 | 2019-09-05 |
| Find all providers with the same taxonomy | ||||
| City | EDWARDSVILLE |
| Zip Code | 62025 |
Please comment or provide details below to improve the information on ICAN CLINIC LLC.
| 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.