Provider Demographics
NPI:1396924866
Name:CENTER FOR CHIROPRACTIC MEDICINE, LTD
Entity type:Organization
Organization Name:CENTER FOR CHIROPRACTIC MEDICINE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROTHENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-649-3422
Mailing Address - Street 1:757 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-2108
Mailing Address - Country:US
Mailing Address - Phone:847-649-3422
Mailing Address - Fax:847-844-4991
Practice Address - Street 1:757 S 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2108
Practice Address - Country:US
Practice Address - Phone:847-649-3422
Practice Address - Fax:847-844-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU87245Medicare UPIN
IL207699Medicare PIN