Provider Demographics
NPI:1952307092
Name:THE SPINE CENTER, S.C
Entity Type:Organization
Organization Name:THE SPINE CENTER, S.C
Other - Org Name:LUTHERAN GENERAL SPINE CENTER, S.C
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-698-9330
Mailing Address - Street 1:1875 DEMPSTER ST
Mailing Address - Street 2:STE 425
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1129
Mailing Address - Country:US
Mailing Address - Phone:847-698-9330
Mailing Address - Fax:847-698-1429
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:STE 425
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1129
Practice Address - Country:US
Practice Address - Phone:847-698-9330
Practice Address - Fax:847-698-1429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
IL207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCJ0089OtherMEDICARE RAILROAD
ILH01135Medicare UPIN
ILD13479Medicare UPIN
ILE99740Medicare UPIN
IL798900Medicare PIN
IL0250220001Medicare NSC