MEDICARE: ACCIDENT AND INJURY CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	204761	OTHER	IL	MEDICARE

General Provider Information

NPI Number	:	1194876656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCIDENT AND INJURY CENTER, INC

Provider Business Mailing Address
First Line	:	12717 S RIDGELAND AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2242
Country	:	US
Telephone Number	:	708-371-6114
Fax Number	:

Provider Business Practice Location Address
First Line	:	12717 S RIDGELAND AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2242
Country	:	US
Telephone Number	:	708-371-6114
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT RICE
Credential	:	DC
Telephone Number	:	708-371-6114

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	06/21/2018

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