1679707236 NPI number — THE SPINAL DECOMPRESSION CENTER

Table of content: ERIKA VARGAS JD LMFT (NPI 1619434834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679707236 NPI number — THE SPINAL DECOMPRESSION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SPINAL DECOMPRESSION CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679707236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 CARLINVILLE PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLINVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62626-1191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-854-9333
Provider Business Mailing Address Fax Number:
217-854-3440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 CARLINVILLE PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLINVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62626-1191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-854-9333
Provider Business Practice Location Address Fax Number:
217-854-3440
Provider Enumeration Date:
05/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TIBURZI
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
217-854-9333

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  038010013 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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