Provider Demographics
NPI:1760554430
Name:NORRIS REHAB CLINIC
Entity Type:Organization
Organization Name:NORRIS REHAB CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-632-2000
Mailing Address - Street 1:920 TALON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1848
Mailing Address - Country:US
Mailing Address - Phone:618-632-2000
Mailing Address - Fax:618-632-2133
Practice Address - Street 1:920 TALON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1848
Practice Address - Country:US
Practice Address - Phone:618-632-2000
Practice Address - Fax:618-632-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL627844OtherUHC
IL5059553OtherAETNA
IL8221298OtherBLUE CROSS BLUE SHIELD
IL888-329-5182OtherGREAT WEST ACN
IL58958OtherGHP
IL58958OtherCMR
MO114856OtherBLUE CROSS BLUE SHIELD
IL1472270OtherFIRST HEALTH
IL382977OtherHEALTHLINK
IL44-02250OtherMEDICARE COMPLETE
IL5059553OtherAETNA
IL58958OtherCMR