Provider Demographics
NPI:1356540561
Name:ILLINOIS SPINAL CARE,LTD.
Entity type:Organization
Organization Name:ILLINOIS SPINAL CARE,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:REDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-617-9790
Mailing Address - Street 1:275 N YORK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2766
Mailing Address - Country:US
Mailing Address - Phone:630-617-9790
Mailing Address - Fax:
Practice Address - Street 1:275 N YORK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2766
Practice Address - Country:US
Practice Address - Phone:630-617-9790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL002233369OtherBC/BS
IL215845Medicare PIN