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General NPI Number Information
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NPI Number | 1922728120
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Entity Type | Organization
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Legal Business Name | ILLINOIS SPINE AND JOINT LLC
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 202 GRANT AVE
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City | GENEVA
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State | IL
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Zip | 60134-1113
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Country | US
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Telephone | 314-488-3743
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Fax |
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Provider Business Mailing Address
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Address Line | 202 GRANT AVE
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City | GENEVA
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State | IL
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Zip | 60134-1113
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Country | US
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Telephone | 314-488-3743
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER B KESSLER
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Credential | D.C.
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Telephone | 314-488-3743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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