# WAUKEGAN MEDICAL AND REHABILITATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Waukegan Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396892352
- **Authorized official:** DR. IVAN BRACIC D.C. (PRESIDENT-OWNER)
- **Authorized official phone:** (847) 625-0202

## Contact information

- **Practice address:** 1720 GRAND AVE, WAUKEGAN, IL 60085-3502
- **Practice address phone:** (847) 625-0202
- **Practice address fax:** (847) 625-0101
- **Mailing address:** 1720 GRAND AVE, WAUKEGAN, IL 60085-3502
- **Mailing address phone:** (847) 625-0202
- **Mailing address fax:** (847) 625-0101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NR0400X | Rehabilitation Chiropractor | 038007449 | IL | Yes |
| 225200000X | Physical Therapy Assistant | 160-004131 | IL | — |

## Other

- **Enumeration date:** 01/04/2007
- **Last updated:** 01/19/2016