Provider Demographics
NPI:1700943321
Name:RACHUM, BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:RACHUM
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 1:6430 CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2310
Mailing Address - Country:US
Mailing Address - Phone:708-749-0100
Mailing Address - Fax:
Practice Address - Street 1:2223 SOUTH OAK PARK AVENUE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-4670
Practice Address - Country:US
Practice Address - Phone:708-749-0100
Practice Address - Fax:708-749-7497
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038-007062OtherSTATE LICENSE NUMBER
IL038-007062OtherSTATE LICENSE NUMBER
ILU84962Medicare UPIN
IL038-007062Medicare ID - Type Unspecified