Provider Demographics
NPI:1164458642
Name:MILRUD CHIROPRACTIC NATURAL CARE & REHAB, INC
Entity Type:Organization
Organization Name:MILRUD CHIROPRACTIC NATURAL CARE & REHAB, INC
Other - Org Name:MILRUD MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILRUD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-740-9200
Mailing Address - Street 1:1829 S CEDAR LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-5711
Mailing Address - Country:US
Mailing Address - Phone:847-740-9200
Mailing Address - Fax:847-740-9215
Practice Address - Street 1:1829 S CEDAR LAKE RD
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-5711
Practice Address - Country:US
Practice Address - Phone:847-740-9200
Practice Address - Fax:847-740-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01628297OtherBCBSIL
IL1248889OtherCIGNA
IL01628297OtherBCBSIL
ILU88407Medicare UPIN
IL213848Medicare ID - Type UnspecifiedGROUP, EFFECTIVE 2006-05-