Provider Demographics
NPI:1023035888
Name:PRACTICAL PRACTITIONERS, LLC
Entity Type:Organization
Organization Name:PRACTICAL PRACTITIONERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICIER
Authorized Official - Prefix:
Authorized Official - First Name:JACQULEINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:708-744-5422
Mailing Address - Street 1:28873 REDFIELD ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-5935
Mailing Address - Country:US
Mailing Address - Phone:800-323-3007
Mailing Address - Fax:888-361-0673
Practice Address - Street 1:10310 S 82ND CT
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1843
Practice Address - Country:US
Practice Address - Phone:708-744-5422
Practice Address - Fax:888-361-0673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX EIN
IL=========OtherTAX EIN