Provider Demographics
NPI:1427197581
Name:HAUSCH MEDICAL SERVICE CORPORATION
Entity Type:Organization
Organization Name:HAUSCH MEDICAL SERVICE CORPORATION
Other - Org Name:MIDWEST CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HAUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-585-5550
Mailing Address - Street 1:11001 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2221
Mailing Address - Country:US
Mailing Address - Phone:773-585-5550
Mailing Address - Fax:773-585-1061
Practice Address - Street 1:11001 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2221
Practice Address - Country:US
Practice Address - Phone:773-585-5550
Practice Address - Fax:773-585-1061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4046624OtherCIGNA HEALTH CARE
1623616OtherBLUE CROSS BLUE SHIELD OF
350049294OtherRAILROAD MEDICARE
7972161OtherAETNA HEALTH
7972161OtherAETNA HEALTH
=========OtherHUMANA
4046624OtherCIGNA HEALTH CARE
=========OtherUNITED HEALTH CARE
U59136Medicare UPIN
IL582870Medicare PIN