Provider Demographics
NPI:1871703686
Name:SCHNACK CHIROPRACTIC CENTER,S.C.
Entity type:Organization
Organization Name:SCHNACK CHIROPRACTIC CENTER,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHNACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-452-9097
Mailing Address - Street 1:2100 JACOBSSEN DR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-2499
Mailing Address - Country:US
Mailing Address - Phone:309-452-9097
Mailing Address - Fax:309-452-8269
Practice Address - Street 1:2100 JACOBSSEN DR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2499
Practice Address - Country:US
Practice Address - Phone:309-452-9097
Practice Address - Fax:309-452-8269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0572-3664OtherBLUECROSSBLUESHIELD
IL902860Medicare ID - Type Unspecified