Provider Demographics
NPI:1114116795
Name:SPINAL HEALTH CLINIC INC
Entity Type:Organization
Organization Name:SPINAL HEALTH CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-766-6200
Mailing Address - Street 1:345 E IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-1621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:630-496-0315
Practice Address - Street 1:345 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1621
Practice Address - Country:US
Practice Address - Phone:630-766-6200
Practice Address - Fax:630-496-0315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty