Provider Demographics
NPI:1972975464
Name:LOOP SPINE & SPORTS CENTER, LTD.
Entity Type:Organization
Organization Name:LOOP SPINE & SPORTS CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENALD
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:TROTTIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-422-0042
Mailing Address - Street 1:6480 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN HEAD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4321
Mailing Address - Country:US
Mailing Address - Phone:312-437-9355
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE STE 605
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3806
Practice Address - Country:US
Practice Address - Phone:312-422-0042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007857111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty