Basic Information
| Provider Information | |||||||||
| NPI: | 1558527473 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MODERN SPINE CARE, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2634 PATRIOT BLVD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600268024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477305618 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2634 PATRIOT BLVD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600268024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477305618 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2008 | ||||||||
| LastUpdateDate: | 12/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | HUBBARD | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | ALLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9492308024 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | 038011145 | IL | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.