Provider Demographics
NPI:1902246283
Name:LIFESPINE CENTER INC.
Entity Type:Organization
Organization Name:LIFESPINE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CURRIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS
Authorized Official - Phone:618-622-9770
Mailing Address - Street 1:4956 BENCHMARK CENTRE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-7605
Mailing Address - Country:US
Mailing Address - Phone:618-622-9770
Mailing Address - Fax:618-622-9773
Practice Address - Street 1:4956 BENCHMARK CENTRE DR
Practice Address - Street 2:SUITE B
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-7605
Practice Address - Country:US
Practice Address - Phone:618-622-9770
Practice Address - Fax:618-622-9773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty