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General NPI Number Information
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NPI Number | 1912174418
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Entity Type | Organization
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Legal Business Name | ST. ANTHONY'S SPINE & JOINT INSTITUTE, P.C.
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 804 W 31ST ST
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City | CHICAGO
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State | IL
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Zip | 60608-5829
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Country | US
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Telephone | 312-842-2447
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Fax |
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Provider Business Mailing Address
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Address Line | 804 W 31ST ST
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City | CHICAGO
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State | IL
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Zip | 60608-5829
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Country | US
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Telephone | 312-842-2447
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MELVIN J. D'SOUZA
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Credential | D.C.
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Telephone | 312-842-2447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 060009430
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License Number State | IL
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