Organization
MEDINAH SPINE & REHABILITATION LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PAMELA BALLARD DC (PRESIDENT)
(630) 307-7463
Entity
Organization
Contact information
Practice address
7N315 SYCAMORE AVE, MEDINAH, IL 60157-9799
(630) 529-0077
(630) 529-0087
Mailing address
PO BOX 460, MEDINAH, IL 60157
(630) 529-0077
(630) 529-0087
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
138006728
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038006728
—
IL
01
—
208982
MEDICARE GRP #
IL
Enumeration date
11/28/2006
Last updated
08/10/2022
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