Provider Demographics
NPI:1699352773
Name:HEALTHY SPINES HEALTHY MINDS
Entity Type:Organization
Organization Name:HEALTHY SPINES HEALTHY MINDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-291-3150
Mailing Address - Street 1:330 S MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1977
Mailing Address - Country:US
Mailing Address - Phone:309-291-3150
Mailing Address - Fax:
Practice Address - Street 1:330 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1976
Practice Address - Country:US
Practice Address - Phone:309-291-3150
Practice Address - Fax:309-279-3469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1194047324OtherBLUE CROSS BLUE SHIELD