Provider Demographics
NPI:1083000970
Name:BLOOMINGTON-NORMAL SPINE CLINIC,PC
Entity Type:Organization
Organization Name:BLOOMINGTON-NORMAL SPINE CLINIC,PC
Other - Org Name:NORMAL SPINE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHIMELPFENIG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-661-2725
Mailing Address - Street 1:2405 G.E.ROAD
Mailing Address - Street 2:#3
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-8597
Mailing Address - Country:US
Mailing Address - Phone:309-661-2725
Mailing Address - Fax:309-661-2730
Practice Address - Street 1:2405 GE RD
Practice Address - Street 2:#3
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-8596
Practice Address - Country:US
Practice Address - Phone:309-661-2725
Practice Address - Fax:309-661-2730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212765Medicare UPIN