Provider Demographics
NPI:1962611772
Name:ADVANCED SPINAL CLINIC P.C.
Entity type:Organization
Organization Name:ADVANCED SPINAL CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-283-4700
Mailing Address - Street 1:5356 W ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3356
Mailing Address - Country:US
Mailing Address - Phone:773-283-4700
Mailing Address - Fax:773-283-4848
Practice Address - Street 1:5356 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-3356
Practice Address - Country:US
Practice Address - Phone:773-283-4700
Practice Address - Fax:773-283-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627562OtherBCBS
ILU86224Medicare UPIN
IL902550Medicare ID - Type Unspecified