Organization
AXIS MEDICAL MANAGEMENT GOUP SC
Active
Other names
New Life Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
JAN STRUWE (OFFICE MANAGER)
(773) 542-1111
Entity
Organization
Contact information
Practice address
4111 W 26TH ST, SUITE 110, CHICAGO, IL 60623-4313
(773) 542-1111
(773) 542-7100
Mailing address
4111 W 26TH ST, SUITE 110, CHICAGO, IL 60623-4313
(773) 542-1111
(773) 542-7100
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
042.618397038.010225
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1634898
BLUE CROSS BLUE SHIELD ID
IL
Enumeration date
04/05/2007
Last updated
04/25/2008
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