Provider Demographics
NPI:1548223019
Name:RUBRIGHT SPINAL REHABILITATION INC
Entity Type:Organization
Organization Name:RUBRIGHT SPINAL REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUBRIGHT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:618-942-7376
Mailing Address - Street 1:905 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948
Mailing Address - Country:US
Mailing Address - Phone:618-942-7376
Mailing Address - Fax:618-942-5321
Practice Address - Street 1:905 S PARK AVE
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948
Practice Address - Country:US
Practice Address - Phone:618-942-7376
Practice Address - Fax:618-942-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
10008333OtherBLUE CROSS
413180OtherHEALTHLINK
P00205242OtherRAILROAD MEDICARE
IL413180OtherBLUE SHIELD
10008333OtherBLUE CROSS
IL413180OtherBLUE SHIELD
U72525Medicare UPIN