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General NPI Number Information
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NPI Number | 1043949290
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Entity Type | Organization
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Legal Business Name | SPINE WORX
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Dates
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Enumeration Date | 06/05/2022
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Last Update Date | 06/05/2022
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Provider Practice Location Address
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Address Line | 4500 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60639-1974
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Country | US
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Telephone | 847-834-9097
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Fax |
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Provider Business Mailing Address
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Address Line | 234 GREENFIELD DR
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City | GLENVIEW
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State | IL
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Zip | 60025-4817
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | OMAR BLEIBEL
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Credential | DC
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Telephone | 847-834-9097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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