Provider Demographics
NPI:1376789545
Name:SPINAL REHABILITATION AND WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:SPINAL REHABILITATION AND WELLNESS CLINIC, LLC
Other - Org Name:NECK TO BACK MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:HINDERLITER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-227-9900
Mailing Address - Street 1:7177 CRIMSON RIDGE DR
Mailing Address - Street 2:STE 7
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6235
Mailing Address - Country:US
Mailing Address - Phone:815-227-9900
Mailing Address - Fax:815-227-9804
Practice Address - Street 1:7177 CRIMSON RIDGE DR
Practice Address - Street 2:STE 7
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6235
Practice Address - Country:US
Practice Address - Phone:815-227-9900
Practice Address - Fax:815-227-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003512111N00000X
IL038009573111NR0400X
IL036037810207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU88386Medicare UPIN
ILT35293Medicare UPIN
ILC37090Medicare UPIN