1093187239 NPI number — PREVENTIVE CARDIOVASCULAR SERVICES & HEALTH SERVICES

Table of content: JEFFREY ALAN RIGBY DPT (NPI 1619132768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093187239 NPI number — PREVENTIVE CARDIOVASCULAR SERVICES & HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREVENTIVE CARDIOVASCULAR SERVICES & HEALTH SERVICES
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:
1093187239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
356 W SUPERIOR ST FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60654-3416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-933-5204
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 S CHICAGO BEACH DR APT 311S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60615-7019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-933-5204
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WICKS, MSC MD MBA
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
PARTNER ACUPUNCTURE & NUTRITION
Authorized Official Telephone Number:
312-933-5204

Provider Taxonomy Codes

  • Taxonomy code: 133NN1002X , 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)





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