Provider Demographics
NPI:1023001815
Name:ILBNC, P.A.
Entity Type:Organization
Organization Name:ILBNC, P.A.
Other - Org Name:INSTITUTE FOR LOW BACK & NECK CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HILGARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-814-6600
Mailing Address - Street 1:3001 METRO DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4506
Mailing Address - Country:US
Mailing Address - Phone:952-814-6600
Mailing Address - Fax:952-814-6700
Practice Address - Street 1:3001 METRO DR
Practice Address - Street 2:SUITE 330
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-4506
Practice Address - Country:US
Practice Address - Phone:952-814-6600
Practice Address - Fax:952-814-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN39370BAOtherBCBS
MN970722100Medicaid
MN76900OtherPREFERRED ONE
MN39370BAOtherBCBS