Organization
AXIS MEDICAL MANAGEMENT GOUP SC
Active
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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