Provider Demographics
NPI:1790907194
Name:RICHART HEALTH SERVICES, LTD.
Entity Type:Organization
Organization Name:RICHART HEALTH SERVICES, LTD.
Other - Org Name:RICHART SPORTS & SPINAL REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-254-7777
Mailing Address - Street 1:15905 S FREDERICK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-7707
Mailing Address - Country:US
Mailing Address - Phone:815-254-7777
Mailing Address - Fax:815-254-5888
Practice Address - Street 1:15905 S FREDERICK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-7707
Practice Address - Country:US
Practice Address - Phone:815-254-7777
Practice Address - Fax:815-254-5888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042617164111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL042617164OtherSTATE LICENSE
1245322940OtherTYPE 1 NPI
IL09923499OtherBLUE SHIELD
IL042617164OtherSTATE LICENSE
ILK25145Medicare ID - Type UnspecifiedMEMBER #
IL09923499OtherBLUE SHIELD