Provider Demographics
NPI:1538469184
Name:CHICAGO SPINE AND SPORTS, P.C.
Entity Type:Organization
Organization Name:CHICAGO SPINE AND SPORTS, P.C.
Other - Org Name:ADVANTAGE HEALTH & WELLNESS, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KREBS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FACO, CSCS
Authorized Official - Phone:773-529-0057
Mailing Address - Street 1:922 W DIVERSEY PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1416
Mailing Address - Country:US
Mailing Address - Phone:773-529-0057
Mailing Address - Fax:773-529-0231
Practice Address - Street 1:922 W DIVERSEY PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1416
Practice Address - Country:US
Practice Address - Phone:773-529-0057
Practice Address - Fax:773-529-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009427111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty