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Organization
INTEGRATIVE SPINE CARE, LLC
Active
Organization
INTEGRATIVE SPINE CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL B JUERGENS M,D. (OWNER/PROVIDER)
(573) 575-6440
Entity
Organization
Contact information
Practice address
364 LAKE INDIAN HILLS CIRCLE, CARBONDALE, IL 62903
(573) 575-6440
(618) 942-7399
Mailing address
364 LAKE INDIAN HILLS CIRCLE, CARBONDALE, IL 62903
(573) 575-6440
(618) 942-7399
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
036067084
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036067084
IL MEDICAL LICENSE
IL
Enumeration date
12/09/2015
Last updated
12/09/2015
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