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Organization
SOUTHERN SPINE & REHAB, PLLC
Active
Organization
SOUTHERN SPINE & REHAB, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOLTEN PEDIGO (OWNER)
(618) 772-2999
Entity
Organization
Contact information
Practice address
1616 W MAIN ST STE 200, MARION, IL 62959-1146
(618) 772-2999
Mailing address
1616 W MAIN ST STE 200, MARION, IL 62959-1146
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
NULL
Other
Enumeration date
01/10/2020
Last updated
02/05/2025
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