Provider Demographics
NPI:1134268022
Name:LAURIE, JAMES ROBER (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBER
Last Name:LAURIE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 RAVINE WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7652
Mailing Address - Country:US
Mailing Address - Phone:847-724-0777
Mailing Address - Fax:847-724-7860
Practice Address - Street 1:2400 RAVINE WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7652
Practice Address - Country:US
Practice Address - Phone:847-724-0777
Practice Address - Fax:847-724-7860
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01620117OtherBLUE CROSS BLUE SHIELD
IL208852Medicare ID - Type Unspecified
IL01620117OtherBLUE CROSS BLUE SHIELD