Provider Demographics
NPI:1952825929
Name:STRAIGHT UP SPINE AND POSTURE, PC
Entity Type:Organization
Organization Name:STRAIGHT UP SPINE AND POSTURE, PC
Other - Org Name:STRAIGHT UP SPINE AND POSTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WINSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:224-656-5778
Mailing Address - Street 1:6021 WASHINGTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5369
Mailing Address - Country:US
Mailing Address - Phone:224-656-5778
Mailing Address - Fax:847-557-4078
Practice Address - Street 1:6021 WASHINGTON ST STE B
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5369
Practice Address - Country:US
Practice Address - Phone:224-656-5778
Practice Address - Fax:847-557-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty