Provider Demographics
NPI:1255641635
Name:BRIA CLINIC PAIN & INJURY RELIEF CENTER SC
Entity type:Organization
Organization Name:BRIA CLINIC PAIN & INJURY RELIEF CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-649-2658
Mailing Address - Street 1:161 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1613
Mailing Address - Country:US
Mailing Address - Phone:630-649-2658
Mailing Address - Fax:
Practice Address - Street 1:161 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60480-1613
Practice Address - Country:US
Practice Address - Phone:630-649-2658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008995111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty