Provider Demographics
NPI:1750877130
Name:CHICAGO SPINAL CARE LLC
Entity type:Organization
Organization Name:CHICAGO SPINAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:GARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-784-6682
Mailing Address - Street 1:1400 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1312
Mailing Address - Country:US
Mailing Address - Phone:773-784-6682
Mailing Address - Fax:
Practice Address - Street 1:1400 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1312
Practice Address - Country:US
Practice Address - Phone:773-784-6682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty