Organization
WAUKEGAN MEDICAL AND REHABILITATION
Active
Other names
Waukegan Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IVAN BRACIC D.C. (PRESIDENT-OWNER)
(847) 625-0202
Entity
Organization
Contact information
Practice address
1720 GRAND AVE, WAUKEGAN, IL 60085-3502
(847) 625-0202
(847) 625-0101
Mailing address
1720 GRAND AVE, WAUKEGAN, IL 60085-3502
(847) 625-0202
(847) 625-0101
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
038007449
IL
225200000X
Physical Therapy Assistant
160-004131
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04932043
BLUE CROSS BLUE SHIELD
IL
Enumeration date
01/04/2007
Last updated
01/19/2016
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