Provider Demographics
NPI:1659422111
Name:SPINE CLINICS OF AMERICA
Entity Type:Organization
Organization Name:SPINE CLINICS OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:POSADA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-432-3162
Mailing Address - Street 1:425 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-1454
Mailing Address - Country:US
Mailing Address - Phone:815-432-3162
Mailing Address - Fax:
Practice Address - Street 1:425 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1454
Practice Address - Country:US
Practice Address - Phone:815-432-3162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty