MEDICARE: CLINICAL NEUROSCIENCES, SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1689628182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL NEUROSCIENCES, SC

Provider Business Mailing Address
First Line	:	8 S MICHIGAN AVE
Second Line	:	SUITE 1505
City	:	CHICAGO
State	:	IL
Zip	:	60603-3357
Country	:	US
Telephone Number	:	312-263-2828
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 S MICHIGAN AVE
Second Line	:	SUITE 1505
City	:	CHICAGO
State	:	IL
Zip	:	60603-3357
Country	:	US
Telephone Number	:	312-263-2828
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	J SLAVICK
Credential	:
Telephone Number	:	312-263-2828

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	09/09/2011

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