| Mount Vernon Chiropractic Clinic | |
|
1315 Main St Mount Vernon IL 62864-3720 | |
| (618) 242-4554 | |
| (618) 242-4653 |
| Full Name | Mount Vernon Chiropractic Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 1315 Main St, Mount Vernon, Illinois |
| Authorized Official Name and Position | Bradley Ray Drake (CHIROPRACTOR) |
| Authorized Official Contact | 6182424554 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mount Vernon Chiropractic Clinic 1315 Main St Mount Vernon IL 62864-3720 Ph: (618) 242-4554 | Mount Vernon Chiropractic Clinic 1315 Main St Mount Vernon IL 62864-3720 Ph: (618) 242-4554 |
| NPI Number | 1881888105 |
|---|---|
| Provider Enumeration Date | 08/29/2007 |
| Last Update Date | 08/29/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881888105 | NPI | - | NPPES |
| 4182010 | Other | IL | BLUE CROSS BLUE SHIELD |
| 038006100 | Medicaid | IL | |
| 350027546 | Other | IL | PALMETTO RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 038006100 (Illinois) | Primary |
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