Provider Demographics
NPI:1508356072
Name:HALO MEDICAL PROFESSIONALS SC.
Entity Type:Organization
Organization Name:HALO MEDICAL PROFESSIONALS SC.
Other - Org Name:HALO MEDICAL PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DN/DC
Authorized Official - Phone:773-239-7740
Mailing Address - Street 1:10650 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-3134
Mailing Address - Country:US
Mailing Address - Phone:773-239-7740
Mailing Address - Fax:773-239-7745
Practice Address - Street 1:10650 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643
Practice Address - Country:US
Practice Address - Phone:773-239-7740
Practice Address - Fax:773-239-7745
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. FREDERIC L. ROBERTSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007303111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty