Organization
LIFE CLINIC, LLC
Active
Other names
Genesis Medical, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES LEE DC (DIRECTOR)
(847) 342-9033
Entity
Organization
Contact information
Practice address
20 E NORTHWEST HWY, MT PROSPECT, IL 60056-3223
(847) 342-9033
Mailing address
2780 PRINCE ST, NORTHBROOK, IL 60062-6540
(847) 342-9033
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
038-007948
IL
122300000X
Dentist
—
IL
2084N0400X
Neurology Physician
Primary
036052025
IL
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
08/01/2011
Last updated
06/26/2015
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