Provider Demographics
NPI:1194759142
Name:NEUROSPINAL CENTER
Entity type:Organization
Organization Name:NEUROSPINAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:KANDILAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-969-4355
Mailing Address - Street 1:519 N CASS AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1514
Mailing Address - Country:US
Mailing Address - Phone:630-969-4355
Mailing Address - Fax:630-969-4527
Practice Address - Street 1:519 N CASS AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1514
Practice Address - Country:US
Practice Address - Phone:630-969-4355
Practice Address - Fax:630-969-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL60-002022261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty