Provider Demographics
NPI:1144598368
Name:ILLINOIS ACUPUNCTURE AND SPINE CLINIC IAS
Entity Type:Organization
Organization Name:ILLINOIS ACUPUNCTURE AND SPINE CLINIC IAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BALDINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-284-0787
Mailing Address - Street 1:PO BOX 925
Mailing Address - Street 2:
Mailing Address - City:HAMPSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-0925
Mailing Address - Country:US
Mailing Address - Phone:847-284-0787
Mailing Address - Fax:
Practice Address - Street 1:2401 ROUTE 20
Practice Address - Street 2:
Practice Address - City:PINGREE GROVE
Practice Address - State:IL
Practice Address - Zip Code:60140
Practice Address - Country:US
Practice Address - Phone:847-284-0787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty