Provider Demographics
NPI:1447307863
Name:DINKLEMANN HEALTH CENTER SC
Entity type:Organization
Organization Name:DINKLEMANN HEALTH CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DINKELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-254-2260
Mailing Address - Street 1:21 E ACTON AVE
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:62095-1918
Mailing Address - Country:US
Mailing Address - Phone:618-254-2260
Mailing Address - Fax:618-254-2231
Practice Address - Street 1:21 E ACTON AVE
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-1918
Practice Address - Country:US
Practice Address - Phone:618-254-2260
Practice Address - Fax:618-254-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL555390Medicare ID - Type Unspecified