Provider Demographics
NPI:1528405545
Name:NORTH SHORE SPINE & WELLNESS INC
Entity Type:Organization
Organization Name:NORTH SHORE SPINE & WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ADI
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEILEM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-966-1955
Mailing Address - Street 1:5833 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3028
Mailing Address - Country:US
Mailing Address - Phone:847-966-1955
Mailing Address - Fax:
Practice Address - Street 1:5833 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3028
Practice Address - Country:US
Practice Address - Phone:847-966-1955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty