NPI 1073291811 · live from the CMS NPI Registry
Active Rehab Chiropractic LLC
Chiropractor in Glen Carbon, IL. National Provider Identifier 1073291811, active.
NPI record
| NPI | 1073291811 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Chiropractor 111N00000X |
| Practice location | 4225 S State Route 159 Ste 2, Glen Carbon, IL 62034 |
| Practice phone | 618-641-3111 |
| Enumerated | July 11, 2023 |
| Last updated | July 11, 2023 |
| Authorized official | Marshall Gevers, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Chiropractor primary | 111N00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.