| Foundation Sport & Spine, Inc. | |
|
415 W Golf Rd Ste 12 Arlington Heights IL 60005-3923 | |
| (847) 342-3000 | |
| (847) 342-3495 |
| Full Name | Foundation Sport & Spine, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 415 W Golf Rd Ste 12, Arlington Heights, Illinois |
| Authorized Official Name and Position | Nathan Jon Porcher (PRESIDENT/OWNER) |
| Authorized Official Contact | 8473423000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Foundation Sport & Spine, Inc. 415 W Golf Rd Ste 12 Arlington Heights IL 60005-3923 Ph: (847) 342-3000 | Foundation Sport & Spine, Inc. 415 W Golf Rd Ste 12 Arlington Heights IL 60005-3923 Ph: (847) 342-3000 |
| NPI Number | 1609211218 |
|---|---|
| Provider Enumeration Date | 05/08/2013 |
| Last Update Date | 03/17/2018 |
| Medicare PECOS PAC ID | 6800022997 |
|---|---|
| Medicare Enrollment ID | O20131120000057 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609211218 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 038012410 (Illinois) | Primary |
| Provider Name | Nathan J Porcher |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1407292550 PECOS PAC ID: 0345476438 Enrollment ID: I20131120000092 |
| Provider Name | Janet Pulvermacher |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1184352684 PECOS PAC ID: 0648638353 Enrollment ID: I20230627002968 |
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