1285603175 NPI number — ROSENBERG CHIROPRACTIC CENTER

Table of content: (NPI 1285603175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285603175 NPI number — ROSENBERG CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSENBERG CHIROPRACTIC CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285603175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
504 N PLUM GROVE RD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
PALATINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60067-8207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-358-0010
Provider Business Mailing Address Fax Number:
847-358-8244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 N PLUM GROVE RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
PALATINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60067-8207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-358-0010
Provider Business Practice Location Address Fax Number:
847-358-8244
Provider Enumeration Date:
03/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROSENBERG
Authorized Official First Name:
SONNY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
847-358-0010

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 213306 . This is a "MEDICARE GROUP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1682549 . This is a "BCBSIL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".