Provider Demographics
NPI:1497814859
Name:INTEGRATIVE NEUROLOGY
Entity Type:Organization
Organization Name:INTEGRATIVE NEUROLOGY
Other - Org Name:INTEGRATIVE NEUROLOGY AND ATHLETIC CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALDINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-229-6673
Mailing Address - Street 1:3805 E MAIN ST STE G
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2487
Mailing Address - Country:US
Mailing Address - Phone:331-222-9667
Mailing Address - Fax:331-222-9657
Practice Address - Street 1:3805 E MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2487
Practice Address - Country:US
Practice Address - Phone:331-222-9667
Practice Address - Fax:331-222-9657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1417932419OtherPERSONAL NPI FOR BALDINO
IL96814Medicare UPIN