Healthcare Provider Details

I. General information

NPI: 1952307092
Provider Name (Legal Business Name): THE SPINE CENTER, S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/21/2022
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST STE 425
PARK RIDGE IL
60068-1129
US

IV. Provider business mailing address

1875 DEMPSTER ST STE 425
PARK RIDGE IL
60068-1129
US

V. Phone/Fax

Practice location:
  • Phone: 847-698-9330
  • Fax: 847-698-1429
Mailing address:
  • Phone: 847-698-9330
  • Fax: 847-698-1429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID SPENCER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-698-9330