Healthcare Provider Details

I. General information

NPI: 1225114846
Provider Name (Legal Business Name): BACK & BODY WORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SOUTH MAIN STREET
LOUISVILLE IL
62858
US

IV. Provider business mailing address

101 SOUTH MAIN STREET
LOUISVILLE IL
62858
US

V. Phone/Fax

Practice location:
  • Phone: 618-665-3070
  • Fax: 618-665-3072
Mailing address:
  • Phone: 618-665-3070
  • Fax: 618-665-3072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-010588
License Number StateIL

VIII. Authorized Official

Name: DR. BRITTANI L RIGGIO
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 618-665-3070