Provider Demographics
NPI:1619145802
Name:NEUROLOGICAL SPINE SPECIALISTS,LLC
Entity Type:Organization
Organization Name:NEUROLOGICAL SPINE SPECIALISTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:J
Authorized Official - Last Name:NARDI
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:708-935-8923
Mailing Address - Street 1:1631 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1305
Mailing Address - Country:US
Mailing Address - Phone:708-935-8923
Mailing Address - Fax:
Practice Address - Street 1:1631 CEDAR RD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1305
Practice Address - Country:US
Practice Address - Phone:708-935-8923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
842OtherCNIM