Provider Demographics
NPI:1740298140
Name:RR MEDICAL MANAGEMENT
Entity type:Organization
Organization Name:RR MEDICAL MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-735-0665
Mailing Address - Street 1:5908 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-0001
Mailing Address - Country:US
Mailing Address - Phone:773-767-3822
Mailing Address - Fax:776-767-3944
Practice Address - Street 1:5908 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2803
Practice Address - Country:US
Practice Address - Phone:773-767-3822
Practice Address - Fax:773-767-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635686OtherBC/BS PROVIDER #
ILH77576Medicare UPIN
IL212553Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #
IL01635686OtherBC/BS PROVIDER #