Provider Demographics
NPI:1457407413
Name:ALLIED PHYSICIANS AND REHAB OF SOUTHERN ILLINOIS, S.C.
Entity Type:Organization
Organization Name:ALLIED PHYSICIANS AND REHAB OF SOUTHERN ILLINOIS, S.C.
Other - Org Name:BIRD CHIROPRACTIC BC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-529-5172
Mailing Address - Street 1:1100 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-2335
Mailing Address - Country:US
Mailing Address - Phone:618-529-5172
Mailing Address - Fax:618-529-9152
Practice Address - Street 1:1100 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2335
Practice Address - Country:US
Practice Address - Phone:618-529-5172
Practice Address - Fax:618-529-9152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
03923662OtherBLUE CROSS BLUE SHIELD
IL042618237OtherMEDICAL LICENSE CORP #