Provider Demographics
NPI:1518208420
Name:ILLINOIS SPINE AND JOINT CENTER LTD.
Entity Type:Organization
Organization Name:ILLINOIS SPINE AND JOINT CENTER LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAMADA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEHYA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-353-5047
Mailing Address - Street 1:5354 N. LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625
Mailing Address - Country:US
Mailing Address - Phone:773-353-5047
Mailing Address - Fax:312-465-1402
Practice Address - Street 1:5354 N. LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:773-353-5047
Practice Address - Fax:312-465-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty