Sunspot Spinal & Sports Rehabilitation

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

042617979 Issued in IL

Legal business name

SUNSPOT SPINAL & SPORTS REHABILITATION

Practice address

8224 Lindenwood LN
Woodridge, IL 60517-4105

Phone

(630) 615-0656

NPI assigned

Feb 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Charles Nathan Bodem, D.C.

Title

Chiropractor

Phone

(630) 615-0656

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297036800000",
    "number": "1316086267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2210",
            "address_2": "105 CANTERBURY LN",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604400138",
            "telephone_number": "630-615-0656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8224 LINDENWOOD LN",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605174105",
            "telephone_number": "630-615-0656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNSPOT SPINAL & SPORTS REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2011-02-07",
        "status": "A",
        "authorized_official_last_name": "BODEM",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "NATHAN",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "630-615-0656",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "042617979",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "042617979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Woodridge, IL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2011; 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.