Provider Demographics
NPI:1144342221
Name:INTEGRATIVE REHABILITATION CENTER, SC
Entity type:Organization
Organization Name:INTEGRATIVE REHABILITATION CENTER, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORGANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:779-423-1700
Mailing Address - Street 1:1820 WINDSOR RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4271
Mailing Address - Country:US
Mailing Address - Phone:815-986-4411
Mailing Address - Fax:815-986-4414
Practice Address - Street 1:101 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4901
Practice Address - Country:US
Practice Address - Phone:779-423-1700
Practice Address - Fax:866-596-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042617556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10132071OtherBLUE CROSS BLUE SHIELD
IL=========OtherEIN
IL203890Medicare PIN
IL=========OtherEIN