Provider Demographics
NPI:1114143088
Name:SPINE & NERVE TESTING CENTER
Entity Type:Organization
Organization Name:SPINE & NERVE TESTING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-775-7979
Mailing Address - Street 1:2634 GRAND AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2458
Mailing Address - Country:US
Mailing Address - Phone:847-775-7979
Mailing Address - Fax:847-775-7975
Practice Address - Street 1:2634 GRAND AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2458
Practice Address - Country:US
Practice Address - Phone:847-775-7979
Practice Address - Fax:847-775-7975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty