Neck to Back Lake County LLC

Primary specialty

Emergency Care Clinic/CenterTaxonomy code 261QE0002X

License

036-104819 Issued in IL

Legal business name

NECK TO BACK LAKE COUNTY LLC

Practice address

71 Waukegan Rd
Suite 100
Lake Bluff, IL 60044-3009

Phone

(847) 283-0950

Fax

(847) 283-0951

NPI assigned

Apr 13, 2007

Organization subpart

No

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

Authorized official

Name

Dr. David Serafini, M.D.

Title

Medical Director

Phone

(847) 283-0950

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209600000000",
    "number": "1750506077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7177 CRIMSON RIDGE DR",
            "address_2": "SUITE 14",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611076208",
            "telephone_number": "815-227-9900",
            "fax_number": "815-227-9805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 WAUKEGAN RD",
            "address_2": "SUITE 100",
            "city": "LAKE BLUFF",
            "state": "IL",
            "postal_code": "600443009",
            "telephone_number": "847-283-0950",
            "fax_number": "847-283-0951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NECK TO BACK LAKE COUNTY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2008-05-01",
        "status": "A",
        "authorized_official_last_name": "SERAFINI",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "847-283-0950",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038010204",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036104819",
            "primary": false
        },
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": "IL",
            "license": "036-104819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin A Murray, PT,DPT
• Phantajah Tanek Myers
• Alexis Bertumen Navares, PHYSICIAN ASSISTANT
• Chaya Naylor
• Hannah Neal, RBT
• Chandini Nerella, BT
• Neurofeedback/Biofeedback of Chicago
• Morgan Roe Newton, P.T.
• Shuk Ching Mable NG
• Hanh Duc Nguyen, RPH

• Emergency Care Clinic/Center in Lake Bluff, IL
• Providers in Lake Bluff, IL by specialty
• Emergency Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.