MEDICARE: SPINE AND JOINT CENTER OF ILLINOIS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	261QP2000X	Physical Therapy Clinic/Center
3	207QS0010X	Sports Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1871201319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE AND JOINT CENTER OF ILLINOIS PLLC

Provider Business Mailing Address
First Line	:	3115 N WILKE RD STE C
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1451
Country	:	US
Telephone Number	:	224-329-5602
Fax Number	:

Provider Business Practice Location Address
First Line	:	3115 N WILKE RD STE C
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1451
Country	:	US
Telephone Number	:	224-329-5602
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MIGENA ZAIMI
Credential	:
Telephone Number	:	224-329-5602

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	11/14/2022

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