=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083000970
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLOOMINGTON-NORMAL SPINE CLINIC,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2015
-----------------------------------------------------
Last Update Date | 06/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2405 GE RD #3
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61704-8596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-661-2725
-----------------------------------------------------
Fax | 309-661-2730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2405 G.E.ROAD #3
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61704-8597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-661-2725
-----------------------------------------------------
Fax | 309-661-2730
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. STEVE K SCHIMELPFENIG
-----------------------------------------------------
Credential | D.C
-----------------------------------------------------
Telephone | 309-661-2725
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038005506
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------