Back to Health Clinic SC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

BACK TO HEALTH CLINIC SC

Practice address

511 N Brush College Rd
Decatur, IL 62521-1652

Phone

(217) 233-0650

Fax

(217) 233-5082

NPI assigned

Apr 4, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Keith Lewis Fabrique, MDNPI 1225196710

Title

President

Phone

(217) 233-0650

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Keith Lewis Fabrique, MD

  • Occupational Medicine Physician
  • Decatur, IL
  • NPI 1225196710
  NPD (past) Authorized official
• Thomas Brian Fulcher, D.C.

  • Chiropractor
  • Springfield, IL
  • NPI 1083770408
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184746984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 N BRUSH COLLEGE RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625211652",
            "telephone_number": "217-233-0650",
            "fax_number": "217-233-5082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 N BRUSH COLLEGE RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625211652",
            "telephone_number": "217-233-0650",
            "fax_number": "217-233-5082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK TO HEALTH CLINIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FABRIQUE",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "LEWIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-233-0650",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Azhar Aslam MD LLC
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• Debra Babich, M.D.
• Baby Talk, Inc.
• Back to Basics Counseling, LLC
• Edward Bacon, LCPC
• Virda Baig, BDS
• Colleen Bailey, RN, BSN, CCRN
• Jordyn Bailey, LCPC
• Timothy S Bailey, M.D.

• Physical Medicine & Rehabilitation Physician in Decatur, IL
• Providers in Decatur, IL by specialty
• Physical Medicine & Rehabilitation Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.