Provider Demographics
NPI:1639437031
Name:CHICAGO ACADEMY OF PAIN MANAGEMENT AND REHABILITATION
Entity Type:Organization
Organization Name:CHICAGO ACADEMY OF PAIN MANAGEMENT AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-419-4214
Mailing Address - Street 1:200 E 75TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-2297
Mailing Address - Country:US
Mailing Address - Phone:773-952-6120
Mailing Address - Fax:773-952-6525
Practice Address - Street 1:200 E 75TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-2297
Practice Address - Country:US
Practice Address - Phone:773-952-6120
Practice Address - Fax:773-952-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty