Organization
BACK TO HEALTH CLINIC SC
Active
Organization
BACK TO HEALTH CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH LEWIS FABRIQUE MD (PRESIDENT)
(217) 233-0650
Entity
Organization
Contact information
Practice address
511 N BRUSH COLLEGE RD, DECATUR, IL 62521-1652
(217) 233-0650
(217) 233-5082
Mailing address
511 N BRUSH COLLEGE RD, DECATUR, IL 62521-1652
(217) 233-0650
(217) 233-5082
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
IL
Other
Enumeration date
04/04/2007
Last updated
08/22/2020
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