Gholson Chiropractic Life & Health LTD

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038008660 Issued in IL

Legal business name

GHOLSON CHIROPRACTIC LIFE & HEALTH LTD

Practice address

1624 W Main St
Carmi, IL 62821-2235

Phone

(618) 384-3621

Fax

(618) 384-2908

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Travis Rhine Gholson, DC

Title

Doctor of Chiropractic

Phone

(618) 384-2631

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250640000000",
    "number": "1457458697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 W MAIN ST",
            "city": "CARMI",
            "state": "IL",
            "postal_code": "628212235",
            "telephone_number": "618-384-2631",
            "fax_number": "618-384-2908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 W MAIN ST",
            "city": "CARMI",
            "state": "IL",
            "postal_code": "628212235",
            "telephone_number": "618-384-3621",
            "fax_number": "618-384-2908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GHOLSON CHIROPRACTIC LIFE & HEALTH LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2009-08-19",
        "status": "A",
        "authorized_official_last_name": "GHOLSON",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "RHINE",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "618-384-2631",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038008660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038008660",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS SHIELD IL",
            "identifier": "09726159",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carl Edward Funkhouser, D.D.S.
• Jaclyn Garner, M.S. CCC-SLP
• Klaire Gebhart
• Don Andrew Gee, RPH
• Lars A Gentry, OD
• Roxanna Lee Gunnels, APRN, NP-C
• Tayler Paige Gutierrez
• Hamilton Memorial Hospital District
• Natalie Beth Hampton
• Patrick Scott Haskell, DC

• All providers in Carmi, IL
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2009; 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.