1639377435 NPI number — NONSURGICAL SPINE & ORTHO CARE, LLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639377435 NPI number — NONSURGICAL SPINE & ORTHO CARE, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NONSURGICAL SPINE & ORTHO CARE, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639377435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 E ARMY TRAIL RD
Provider Second Line Business Mailing Address:
SUITE 407
Provider Business Mailing Address City Name:
BLOOMINGDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60108-2169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-980-4922
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 E ARMY TRAIL RD
Provider Second Line Business Practice Location Address:
SUITE 407
Provider Business Practice Location Address City Name:
BLOOMINGDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60108-2169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-980-4922
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUDOBA
Authorized Official First Name:
PAVEL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
630-980-4922

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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