Provider Demographics
NPI:1891913828
Name:SPINAL REHABILITATION ASSOCIATES, INC.
Entity Type:Organization
Organization Name:SPINAL REHABILITATION ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-554-6111
Mailing Address - Street 1:5 E. WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543
Mailing Address - Country:US
Mailing Address - Phone:630-554-6111
Mailing Address - Fax:630-554-6166
Practice Address - Street 1:751 ROOSEVELT RD. STE 218
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137
Practice Address - Country:US
Practice Address - Phone:630-469-1527
Practice Address - Fax:630-469-1841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
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