Provider Demographics
NPI:1669792917
Name:SPINE ARC, INC
Entity type:Organization
Organization Name:SPINE ARC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:RZESZUTEK
Authorized Official - Suffix:
Authorized Official - Credentials:DN
Authorized Official - Phone:312-226-3800
Mailing Address - Street 1:805 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-1256
Mailing Address - Country:US
Mailing Address - Phone:312-226-3800
Mailing Address - Fax:
Practice Address - Street 1:805 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-1256
Practice Address - Country:US
Practice Address - Phone:312-226-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181000283172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172P00000XOther Service ProvidersNaprapathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1932329786OtherNPI