Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 038008186 | IL |
NPI | 1265558837 |
---|---|
Provider Name | Dr. Joseph C Probst |
First Address | South Beloit, IL 61080-1431 |
Second Address | South Beloit, IL 61080-1431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 06/08/2018 |