LIFESTYLE REJUVENATION MEDICAL GROUP PLLC

CHICAGO, IL
NPI1134781974
Entity TypeOrganization
Authorized ContactROBERT VAN HIGGINBOTTOM
CEO
773-667-9053
Organization Subpart ?No
Primary Taxonomy261QM1300X Clinic/Center, Multi-Specialty
Additional Taxonomies111N00000X Chiropractor
111NR0400X Chiropractor, Rehabilitation
261QH0100X Clinic/Center, Health Services
261QM2500X Clinic/Center, Medical Specialty
261QP2000X Clinic/Center, Physical Therapy
261QP2300X Clinic/Center, Primary Care
261QP3300X Clinic/Center, Pain
261QR0200X Clinic/Center, Radiology
261QR0400X Clinic/Center, Rehabilitation
261QR0800X Clinic/Center, Recovery Care
302R00000X Health Maintenance Organization
305R00000X Preferred Provider Organization
305S00000X Point of Service
332B00000X Durable Medical Equipment & Medical Supplies
Enumeration Date2019-07-02
Last Update Date2020-05-29
Business Address
LIFESTYLE REJUVENATION MEDICAL GROUP PLLC
1740 E 55TH STREET
CHICAGO, IL 60615
Phone number: 773-667-9053
Mailing Address
LIFESTYLE REJUVENATION MEDICAL GROUP PLLC
1740 E 55TH ST
CHICAGO, IL 60615-5966
Phone number: 773-667-9053