Provider Demographics
NPI:1316192628
Name:CHICAGO SPORTS AND SPINE, LLC
Entity Type:Organization
Organization Name:CHICAGO SPORTS AND SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BALJINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:BATHLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-576-5264
Mailing Address - Street 1:1550 S INDIANA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2857
Mailing Address - Country:US
Mailing Address - Phone:312-623-7246
Mailing Address - Fax:312-583-9300
Practice Address - Street 1:1550 S INDIANA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2857
Practice Address - Country:US
Practice Address - Phone:312-576-5264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116037208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6692450001Medicare NSC