Healthcare Provider Details

I. General information

NPI: 1235073909
Provider Name (Legal Business Name): INTRANERVE NEUROSCIENCE HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S WEBER ST STE 200
COLORADO SPRINGS CO
80903-1928
US

IV. Provider business mailing address

1049 KEYSTONE AVE
NORTHBROOK IL
60062-3688
US

V. Phone/Fax

Practice location:
  • Phone: 866-226-8576
  • Fax:
Mailing address:
  • Phone: 312-771-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number State

VIII. Authorized Official

Name: BAILEY RUTH ONIXT
Title or Position: IONM
Credential:
Phone: 312-771-2014