Provider Demographics
NPI:1982057790
Name:SPINE AND BODY HEALTH
Entity Type:Organization
Organization Name:SPINE AND BODY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NAPRAPATH
Authorized Official - Prefix:DR
Authorized Official - First Name:MILADY
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DN
Authorized Official - Phone:773-392-3695
Mailing Address - Street 1:2630 W DIVISION ST
Mailing Address - Street 2:1ST FL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3312
Mailing Address - Country:US
Mailing Address - Phone:773-392-3695
Mailing Address - Fax:
Practice Address - Street 1:2642 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-8179
Practice Address - Country:US
Practice Address - Phone:773-392-3695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-16
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181.000388172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172P00000XOther Service ProvidersNaprapathGroup - Multi-Specialty