| Southern Spine & Rehab, Pllc | |
|
1616 W Main St Ste 200 Marion IL 62959-1146 | |
| (618) 772-2999 | |
| Not Available |
| Full Name | Southern Spine & Rehab, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1616 W Main St Ste 200, Marion, Illinois |
| Authorized Official Name and Position | Kolten Pedigo (OWNER) |
| Authorized Official Contact | 6187722999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Spine & Rehab, Pllc 1616 W Main St Ste 503 Marion IL 62959-1146 Ph: () - | Southern Spine & Rehab, Pllc 1616 W Main St Ste 200 Marion IL 62959-1146 Ph: (618) 772-2999 |
| NPI Number | 1083254734 |
|---|---|
| Provider Enumeration Date | 01/10/2020 |
| Last Update Date | 02/17/2023 |
| Medicare PECOS PAC ID | 0648644807 |
|---|---|
| Medicare Enrollment ID | O20230330000408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083254734 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Kolten K Pedigo |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1568001907 PECOS PAC ID: 4587034384 Enrollment ID: I20230330000359 |
| Provider Name | Emily J Dickman |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1093465049 PECOS PAC ID: 4082088265 Enrollment ID: I20230330001441 |
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