MEDICARE: THE SPINE CENTER, S.C

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	207XS0117X	Orthopaedic Surgery of the Spine Physician		IL
2	207X00000X	Orthopaedic Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ0089	OTHER	IL	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1952307092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SPINE CENTER, S.C

Provider Business Mailing Address
First Line	:	1875 DEMPSTER ST
Second Line	:	STE 425
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-1129
Country	:	US
Telephone Number	:	847-698-9330
Fax Number	:	847-698-1429

Provider Business Practice Location Address
First Line	:	1875 DEMPSTER ST
Second Line	:	STE 425
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-1129
Country	:	US
Telephone Number	:	847-698-9330
Fax Number	:	847-698-1429

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID SPENCER
Credential	:	M.D.
Telephone Number	:	847-698-9330

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/21/2022

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Directions to “THE SPINE CENTER, S.C ” Practice Location

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