Provider Demographics
NPI:1770611386
Name:JOINT & SPINE REHABILITATION OF NORTHERN ILLINOIS
Entity type:Organization
Organization Name:JOINT & SPINE REHABILITATION OF NORTHERN ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOILEVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-266-0960
Mailing Address - Street 1:1866 SHERIDAN RD STE 317
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2546
Mailing Address - Country:US
Mailing Address - Phone:847-266-0960
Mailing Address - Fax:847-266-0961
Practice Address - Street 1:1866 SHERIDAN RD STE 317
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2546
Practice Address - Country:US
Practice Address - Phone:847-266-0960
Practice Address - Fax:847-266-0961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004203261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04927913OtherBCBS
ILT37649Medicare UPIN