Provider Demographics
NPI:1437275815
Name:SPINE CENTERS INSTITUTE, INC.
Entity Type:Organization
Organization Name:SPINE CENTERS INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:STRONGIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-878-7909
Mailing Address - Street 1:5252 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2448
Mailing Address - Country:US
Mailing Address - Phone:773-878-7909
Mailing Address - Fax:773-878-2311
Practice Address - Street 1:601 W RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2232
Practice Address - Country:US
Practice Address - Phone:773-878-7909
Practice Address - Fax:773-878-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1473456261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical