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General NPI Number Information
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NPI Number | 1639377435
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Entity Type | Organization
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Legal Business Name | NONSURGICAL SPINE & ORTHO CARE, LLC.
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 303 E ARMY TRAIL RD SUITE 407
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2169
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Country | US
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Telephone | 630-980-4922
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Fax |
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Provider Business Mailing Address
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Address Line | 303 E ARMY TRAIL RD SUITE 407
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2169
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Country | US
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Telephone | 630-980-4922
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. PAVEL HUDOBA
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Credential | M.D.
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Telephone | 630-980-4922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State | IL
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