Back & Spine Medical Institute
NPI #1871690081 in Fairview Heights, Illinois
Provider Information
- NPI Number
- 1871690081
- Entity Type
- Organization
- Organization Name
- Back & Spine Medical Institute
- Primary Specialty
- Physical Therapist
- Enumeration Date
- Sep 20, 2006
- Last Updated
- Nov 16, 2007
Practice Location
- Address
- 5300 N ILLINOIS ST
- City
- Fairview Heights
- State
- Illinois
- ZIP Code
- 62208-3500
- Phone
- (618) 222-2222
Authorized Official
- Name
- DR. RANDY JOHNSON
- Title
- MD/OWNER
- Phone
- (314) 781-8082
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physical Therapist |
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