Organization
DUPAGE SPINE ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN FAUTSCH (CO-OWNER)
(310) 795-4690
Entity
Organization
Contact information
Practice address
900 N FRANKLIN ST, SUITE 407, CHICAGO, IL 60610-8100
(773) 426-5742
Mailing address
900 N FRANKLIN ST, SUITE 407, CHICAGO, IL 60610-8100
(773) 426-5742
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750700779
NPI
IL
Enumeration date
06/25/2015
Last updated
06/25/2015
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