Organization
LIFESTYLE CHIROPRACTIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT VAN HIGGINBOTTOM DC (PRESIDENT)
(773) 667-9053
Entity
Organization
Contact information
Practice address
1746 E 55TH STREET, CHICAGO, IL 60615
(773) 667-9053
(773) 667-9084
Mailing address
1746 E 55TH STREET, CHICAGO, IL 60615
(773) 667-9053
(773) 667-9084
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20995
MEDICARE GROUP #
IL
Enumeration date
01/30/2008
Last updated
01/30/2008
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