Healthcare Provider Details

I. General information

NPI: 1588997324
Provider Name (Legal Business Name): ILLINOIS SPINE AND DISC INSTITUTE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 S MCLEAN BLVD
ELGIN IL
60123-6703
US

IV. Provider business mailing address

810 S MCLEAN BLVD
ELGIN IL
60123-6703
US

V. Phone/Fax

Practice location:
  • Phone: 847-697-3472
  • Fax: 847-697-3475
Mailing address:
  • Phone: 847-697-3472
  • Fax: 847-697-3475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number038-009584
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number038009584
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036-124389
License Number StateIL

VIII. Authorized Official

Name: DR. STUART C. HUI
Title or Position: SECRETARY
Credential: DC, ATC/L
Phone: 847-833-9354