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General NPI Number Information
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NPI Number | 1770611386
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Entity Type | Organization
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Legal Business Name | JOINT & SPINE REHABILITATION OF NORTHERN ILLINOIS
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 1866 SHERIDAN RD STE 317
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2546
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Country | US
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Telephone | 847-266-0960
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Fax | 847-266-0961
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Provider Business Mailing Address
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Address Line | 1866 SHERIDAN RD STE 317
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2546
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Country | US
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Telephone | 847-266-0960
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Fax | 847-266-0961
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Authorized Official
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Title or Position | DIRECTOR
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Name | CARLOS M BOILEVE
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Credential | DC
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Telephone | 847-266-0960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 038-004203
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License Number State | IL
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