Provider Demographics
NPI:1235393810
Name:MURPHY SPINE & SPORTS INC.
Entity Type:Organization
Organization Name:MURPHY SPINE & SPORTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-483-3223
Mailing Address - Street 1:25158 W EAMES ST
Mailing Address - Street 2:UNIT G
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-5404
Mailing Address - Country:US
Mailing Address - Phone:815-483-3223
Mailing Address - Fax:
Practice Address - Street 1:25158 W EAMES ST
Practice Address - Street 2:UNIT G
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-5404
Practice Address - Country:US
Practice Address - Phone:815-467-4466
Practice Address - Fax:815-467-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010739261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center