Back to Life Chiropractic, SC

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

038010264 Issued in IL

Legal business name

BACK TO LIFE CHIROPRACTIC, SC

Practice address

1352 Patriot Blvd
Glenview, IL 60026-7777

Phone

(847) 917-3097

NPI assigned

May 30, 2008

Organization subpart

No

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

Authorized official

Name

Thomas Godbout IIINPI 1669500104

Title

President

Phone

(847) 917-3097

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 4

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

• Thomas G Godbout III, D.C., CCSP

  • Sports Physician Chiropractor
  • Glenview, IL
  • NPI 1669500104
  Medicare reassignment NPD Authorized official
• Steven Liska, PT, DPT, ATC, CSCS

  • Physical Therapist
  • Glenview, IL
  • NPI 1639503808
  NPD
• Kristy Stahr, PT

  • Physical Therapist
  • Glenview, IL
  • NPI 1124220066
  NPD
• Justin Silver, PT,MPT

  • Physical Therapist
  • Glenview, IL
  • NPI 1992897425
  NPD (past)

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

{
    "created_epoch": "1212105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220486400000",
    "number": "1194983650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "454 N IDA LN",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601262210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1352 PATRIOT BLVD",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600267777",
            "telephone_number": "847-917-3097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK TO LIFE CHIROPRACTIC, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-30",
        "last_updated": "2008-09-04",
        "status": "A",
        "authorized_official_last_name": "GODBOUT",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-917-3097",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "IL",
            "license": "038010264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "216661",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ayur Soul Care Inc
• Ayzenshteyn Chiropractic (S&A Chiropractic)
• Elham Azizi, MD
• Martina Azizi, DPT
• Soya Babu
• Abigail Backer
• Badegian Dental Group, P.C.
• Jane Ellen Badegian, DDS
• Cheryl Eileen Baehr, PTA
• Hafsa Nusreth Baig, MD

• Sports Physician Chiropractor in Glenview, IL
• Providers in Glenview, IL by specialty
• Sports Physician Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.