| Organization Name: | BACK & SPINE MEDICAL INSTITUTE |
| NPI Number: | 1871690081 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RANDY JOHNSON (MD/OWNER) |
| Mailing Address: | 5300 N Illinois St Fairview Heights |
| State: | IL US |
| Postal Code: | 622083500 |
| Phone Number: | 6182222222 |
| Fax Number: | |
| NPI Enumeration Date: | 09/20/2006 |
| NPI Last Update Date: | 11/16/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |