Taylorville Chiropractic Clinic LTD.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038006559 Issued in IL

Legal business name

TAYLORVILLE CHIROPRACTIC CLINIC LTD.

Doing business as

Spinal Care Center

Practice address

2339 Pontoon Road
Granite City, IL 62040

Phone

(618) 931-2050

Fax

(314) 895-5040

NPI assigned

Jan 13, 2006

Last updated

Jul 22, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

TAYLORVILLE CHIROPRACTIC CLINIC LTD.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Philip S Dudak, DC

Title

President of Corporation

Phone

(618) 931-2050

Specialties & licenses 1

Addresses

Other names 1

• Spinal Care Center Doing business as

Part of

Christian County Chirop

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1063491389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2339 PONTOON ROAD",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "62040",
            "telephone_number": "618-931-2050",
            "fax_number": "314-895-5040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2339 PONTOON ROAD",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "62040",
            "telephone_number": "618-931-2050",
            "fax_number": "314-895-5040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAYLORVILLE CHIROPRACTIC CLINIC LTD.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TAYLORVILLE CHIROPRACTIC CLINIC LTD.",
        "enumeration_date": "2006-01-13",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "DUDAK",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT OF CORPORATION",
        "authorized_official_telephone_number": "618-931-2050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038006559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spinal Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Granite City, IL
• Providers in Granite City, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.