Provider Demographics
NPI:1538363064
Name:QUAD CITY SPINE CLINIC
Entity type:Organization
Organization Name:QUAD CITY SPINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MARING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-764-7272
Mailing Address - Street 1:1523 47TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7089
Mailing Address - Country:US
Mailing Address - Phone:309-764-7272
Mailing Address - Fax:309-764-6858
Practice Address - Street 1:1523 47TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7089
Practice Address - Country:US
Practice Address - Phone:309-764-7272
Practice Address - Fax:309-764-6858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL242499OtherMIDLAND CHOICE
IL08132046OtherBLUE CROSS BLUE SHIELD
ILU96803Medicare UPIN
IL242499OtherMIDLAND CHOICE