Provider Demographics
NPI:1174692537
Name:COMPREHENSIVE FAMILY HEALTH CENTER, SC
Entity type:Organization
Organization Name:COMPREHENSIVE FAMILY HEALTH CENTER, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:RANALLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-683-0077
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:HAMPSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60140
Mailing Address - Country:US
Mailing Address - Phone:847-683-0077
Mailing Address - Fax:847-683-1022
Practice Address - Street 1:184 S STATE ST
Practice Address - Street 2:
Practice Address - City:HAMPSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60140-7000
Practice Address - Country:US
Practice Address - Phone:847-683-0077
Practice Address - Fax:847-683-1022
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE FAMILY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 225100000X
IL038.007049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207829Medicare PIN
IL207829Medicare UPIN
ILK02615Medicare UPIN