14D2071747 CLIA NUMBER - ILLINOIS BACK & NECK INSTITUTE L L C

Laboratory Demographics

  • CLIA Code: 14D2071747
  • Facility Name: ILLINOIS BACK & NECK INSTITUTE L L C
  • Facility Address: 830 N ASHLAND AVE, 1-N
    CHICAGO, IL
    ZIP 60622
  • Facility Phone: 773 485-0278
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NEEMA BAYRAN M D
  • NPI Number: 1023046448
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 14D2071747
LAB Type Physician Office
Facility Name ILLINOIS BACK & NECK INSTITUTE L L C
Street 830 N ASHLAND AVE, 1-N
City CHICAGO
State IL
ZIP 60622
Phone 773 485-0278
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/17/2024
Certificate Expiration Date 1/16/2026
Facility Type Physician Office
Lab Director NEEMA BAYRAN M D

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This page was last updated on: 9/29/2025