Provider Demographics
NPI:1184370538
Name:WICKER PARK SPINE AND STABILITY, LLC
Entity type:Organization
Organization Name:WICKER PARK SPINE AND STABILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:HEATHER
Authorized Official - Last Name:KIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-928-9282
Mailing Address - Street 1:212 N CARPENTER ST UNIT A1A2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1713
Mailing Address - Country:US
Mailing Address - Phone:312-928-9282
Mailing Address - Fax:312-588-7211
Practice Address - Street 1:1641-1643 W NORTH AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:312-928-9282
Practice Address - Fax:312-588-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty