Provider Demographics
NPI:1619381985
Name:SPINE CARE CENTER PC
Entity Type:Organization
Organization Name:SPINE CARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARCHALOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-347-7580
Mailing Address - Street 1:2190 GLADSTONE DR. UNIT B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139
Mailing Address - Country:US
Mailing Address - Phone:639-347-7580
Mailing Address - Fax:312-377-1664
Practice Address - Street 1:2190 GLADSTONE CT
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1519
Practice Address - Country:US
Practice Address - Phone:630-347-7580
Practice Address - Fax:312-377-1664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181.000374172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172P00000XOther Service ProvidersNaprapathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1720351596OtherNAPRAPATHYPA
IL1720351596OtherNAPRAPATHY