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General NPI Number Information
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NPI Number | 1639929276
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Entity Type | Organization
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Legal Business Name | CHI-TOWN SPINE AND SPORT PLLC
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Dates
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Enumeration Date | 03/26/2024
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 4610 N WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2184
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Country | US
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Telephone | 773-275-5031
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Fax |
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Provider Business Mailing Address
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Address Line | 4610 N WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2184
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Country | US
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Telephone | 773-275-5031
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSE LUIS RAMIREZ
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Credential | DC
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Telephone | 773-209-9394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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