Southern Illinois Sport and Spine LLC

NPI #1215277967 in Benton, Illinois

Provider Information

NPI Number: 1215277967
Entity Type: Organization
Organization Name: Southern Illinois Sport and Spine LLC
Primary Specialty: Chiropractor
Enumeration Date: Feb 17, 2013
Last Updated: May 7, 2013

Practice Location

Address: 106 W WASHINGTON ST
City: Benton
State: Illinois
ZIP Code: 62812-1337
Phone: (618) 435-3888

Authorized Official

Name: LUKE WILLIAM KOEHN, D.C.
Title: CHIROPRACTOR
Phone: (618) 521-0552

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Chiropractor	111N00000X	Primary

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