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Organization
LIFESTYLE REJUVENATION MEDICAL GROUP PLLC
Active
Organization
LIFESTYLE REJUVENATION MEDICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT VAN HIGGINBOTTOM DC (CEO)
(773) 667-9053
Entity
Organization
Contact information
Practice address
1740 E 55TH STREET, CHICAGO, IL 60615
(773) 667-9053
Mailing address
1740 E 55TH ST, CHICAGO, IL 60615-5966
(773) 667-9053
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
NULL
111N00000X
Chiropractor
—
—
111NR0400X
Rehabilitation Chiropractor
—
NULL
111NR0400X
Rehabilitation Chiropractor
—
—
261QH0100X
Health Service Clinic/Center
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
261QM2500X
Medical Specialty Clinic/Center
—
NULL
261QP2000X
Physical Therapy Clinic/Center
—
NULL
261QP2300X
Primary Care Clinic/Center
—
NULL
261QP3300X
Pain Clinic/Center
—
NULL
261QR0200X
Radiology Clinic/Center
—
NULL
261QR0400X
Rehabilitation Clinic/Center
—
NULL
261QR0800X
Recovery Care Clinic/Center
—
NULL
302R00000X
Health Maintenance Organization
—
NULL
305R00000X
Preferred Provider Organization
—
NULL
305S00000X
Point of Service
—
NULL
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
Other
Enumeration date
07/02/2019
Last updated
05/29/2020
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