Provider Demographics
NPI:1194197376
Name:NATURAL PAIN BACK INSTITUTE, LLC
Entity Type:Organization
Organization Name:NATURAL PAIN BACK INSTITUTE, LLC
Other - Org Name:C/E MED BACK INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:RODGES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:662-843-0076
Mailing Address - Street 1:506 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2362
Mailing Address - Country:US
Mailing Address - Phone:662-843-0076
Mailing Address - Fax:662-846-7730
Practice Address - Street 1:3535 E NEW YORK ST
Practice Address - Street 2:SUITE 216
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4465
Practice Address - Country:US
Practice Address - Phone:662-843-0076
Practice Address - Fax:662-846-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
208D00000X, 225100000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302G704130Medicare UPIN