Provider Demographics
NPI:1740760826
Name:ACADEMIC SPINE CONSULTANTS, LLC
Entity Type:Organization
Organization Name:ACADEMIC SPINE CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NECKRYSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-450-5880
Mailing Address - Street 1:455 N CITYFRONT PLAZA DR STE 3100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5328
Mailing Address - Country:US
Mailing Address - Phone:312-561-2329
Mailing Address - Fax:312-561-2302
Practice Address - Street 1:455 N CITYFRONT PLAZA DR STE 3100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5328
Practice Address - Country:US
Practice Address - Phone:312-561-2329
Practice Address - Fax:312-561-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113099207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty