Provider Demographics
NPI:1689628182
Name:CLINICAL NEUROSCIENCES, SC
Entity Type:Organization
Organization Name:CLINICAL NEUROSCIENCES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAVICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-263-2828
Mailing Address - Street 1:8 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 1505
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3357
Mailing Address - Country:US
Mailing Address - Phone:312-263-2828
Mailing Address - Fax:
Practice Address - Street 1:8 S MICHIGAN AVE
Practice Address - Street 2:SUITE 1505
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3357
Practice Address - Country:US
Practice Address - Phone:312-263-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H69501Medicare UPIN
84248Medicare ID - Type UnspecifiedSMITH
202433Medicare ID - Type UnspecifiedOROZCO
329220Medicare ID - Type UnspecifiedGROUP
C42344Medicare UPIN
I14035Medicare UPIN
Q25310Medicare UPIN
K23202Medicare ID - Type UnspecifiedSIMON
491050Medicare ID - Type UnspecifiedSLAVICK