Provider Demographics
NPI:1982952552
Name:SPORT & SPINE REHAB INSTITUTE
Entity Type:Organization
Organization Name:SPORT & SPINE REHAB INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLECKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:262-818-3795
Mailing Address - Street 1:PO BOX 4588
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-4588
Mailing Address - Country:US
Mailing Address - Phone:262-818-3795
Mailing Address - Fax:
Practice Address - Street 1:200 E ROOSEVELT RD
Practice Address - Street 2:JANSE HALL
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4539
Practice Address - Country:US
Practice Address - Phone:262-818-3795
Practice Address - Fax:630-277-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty