Provider Demographics
NPI:1417208331
Name:ADVANCED SPINE AND PAIN SPECIALISTS, S.C.
Entity Type:Organization
Organization Name:ADVANCED SPINE AND PAIN SPECIALISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHUNDURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-952-2226
Mailing Address - Street 1:6524 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2400
Mailing Address - Country:US
Mailing Address - Phone:773-717-0890
Mailing Address - Fax:866-585-0302
Practice Address - Street 1:6524 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2400
Practice Address - Country:US
Practice Address - Phone:773-717-0890
Practice Address - Fax:866-585-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty