Provider Demographics
NPI:1548380868
Name:SOMA HEALTHCARE CENTER SC
Entity Type:Organization
Organization Name:SOMA HEALTHCARE CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUGG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-530-4500
Mailing Address - Street 1:360 W BUTTERFIELD RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5068
Mailing Address - Country:US
Mailing Address - Phone:630-530-4500
Mailing Address - Fax:630-833-9680
Practice Address - Street 1:901 BIESTERFIELD RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3392
Practice Address - Country:US
Practice Address - Phone:847-437-7070
Practice Address - Fax:847-437-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208888OtherMEDICARE PROVIDER NUMBER