Organization Name: | MIND BODY SPIRIT CARE CLINIC INC |
NPI Number: | 1104007756 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CATHERINE DEANNE MARSHALL (PRESIDENT-OWNER/PROVIDER) |
Mailing Address: | 9640 Mallard Dr Mascoutah |
State: | IL US |
Postal Code: | 622582762 |
Phone Number: | 6189608796 |
Fax Number: | |
NPI Enumeration Date: | 11/23/2007 |
NPI Last Update Date: | 11/23/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |