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General NPI Number Information
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NPI Number | 1669792917
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Entity Type | Organization
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Legal Business Name | SPINE ARC, INC
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Dates
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Enumeration Date | 06/09/2010
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Last Update Date | 06/09/2010
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Provider Practice Location Address
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Address Line | 805 N MILWAUKEE AVE
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City | CHICAGO
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State | IL
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Zip | 60642-1256
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Country | US
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Telephone | 312-226-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 805 N MILWAUKEE AVE
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City | CHICAGO
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State | IL
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Zip | 60642-1256
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Country | US
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Telephone | 312-226-3800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL RZESZUTEK
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Credential | D.N.
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Telephone | 312-226-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172P00000X
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Taxonomy Name | Naprapath
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License Number | 181000283
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License Number State | IL
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