Medinah Spine & Rehabilitation LTD

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

138006728 Issued in IL

Legal business name

MEDINAH SPINE & REHABILITATION LTD

Practice address

7N315 Sycamore Ave
Medinah, IL 60157-9799

Phone

(630) 529-0077

Fax

(630) 529-0087

NPI assigned

Nov 28, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Pamela Ballard, DC

Title

President

Phone

(630) 307-7463

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 2

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

• Michael R. Oster, DPM

  • Foot & Ankle Surgery Podiatrist
  • Chicago, IL
  • NPI 1073629531
  NPD (past)
• Conway T McLean, DPM

  • Podiatrist
  • Marquette, MI
  • NPI 1215085790
  NPD (past)

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660089600000",
    "number": "1265508469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 460",
            "city": "MEDINAH",
            "state": "IL",
            "postal_code": "60157",
            "telephone_number": "630-529-0077",
            "fax_number": "630-529-0087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7N315 SYCAMORE AVE",
            "city": "MEDINAH",
            "state": "IL",
            "postal_code": "601579799",
            "telephone_number": "630-529-0077",
            "fax_number": "630-529-0087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDINAH SPINE & REHABILITATION LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A",
        "authorized_official_last_name": "BALLARD",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-307-7463",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "138006728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038006728",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GRP #",
            "identifier": "208982",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Philip Frystak, DDS
• Aleksandra Gierasimiuk
• International Therapy Partners
• Laugh & Learn Educational Services, LTD.
• Kathleen P Marino
• Lauren Ashley Prena, M.ED.
• Alyvia Kathryn Susan Provost, M.S., CF-SLP
• Nicole Rood, MA, CCC-SLP
• Jehu Ruelo Rueles
• Kelli Sander, RBT-18-71726

• Chiropractor in Medinah, IL
• Providers in Medinah, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; 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.