| Pro-active Care Physical Medicine Sc | |
|
2609 W Lawrence Ave, Chicago, IL 60625-6895 | |
| (773) 279-9344 | |
| (773) 279-9345 |
| Full Name | Pro-active Care Physical Medicine Sc |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 2609 W Lawrence Ave, Chicago, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356600712 | NPI | - | NPPES |
| IL7812 | Other | IL | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | 038010690 (Illinois) | Primary |
| Provider Name | Rae Bouvin |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1891727145 PECOS PAC ID: 1759534902 Enrollment ID: I20240312001485 |
| Mailing Address | Practice Location Address |
|---|---|
| Pro-active Care Physical Medicine Sc 2609 W Lawrence Ave, Chicago, IL 60625-6895 Ph: (773) 279-9344 | Pro-active Care Physical Medicine Sc 2609 W Lawrence Ave, Chicago, IL 60625-6895 Ph: (773) 279-9344 |
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