Provider Demographics
NPI:1629270244
Name:LAKE COUNTY HEALTH PAIN & REHABILITATION CENTER S.C
Entity Type:Organization
Organization Name:LAKE COUNTY HEALTH PAIN & REHABILITATION CENTER S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-949-4200
Mailing Address - Street 1:524 N. LAKE STREET
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1827
Mailing Address - Country:US
Mailing Address - Phone:847-949-4200
Mailing Address - Fax:
Practice Address - Street 1:524 N LAKE STREET
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1827
Practice Address - Country:US
Practice Address - Phone:847-949-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007291111N00000X
IL0038-007291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
205811Medicare PIN
U49182Medicare UPIN