Provider Demographics
NPI:1124408315
Name:SPINE REHABILITATION AND WELLNESS INC
Entity Type:Organization
Organization Name:SPINE REHABILITATION AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF NAPRAPATHY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DN
Authorized Official - Phone:708-542-0077
Mailing Address - Street 1:703 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1828
Mailing Address - Country:US
Mailing Address - Phone:708-542-0077
Mailing Address - Fax:
Practice Address - Street 1:703 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1828
Practice Address - Country:US
Practice Address - Phone:708-542-0077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172P00000XOther Service ProvidersNaprapathGroup - Single Specialty