MEDICARE: CHICAGO HEIGHTS PAIN CENTER, P.C.

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	111NR0400X	Rehabilitation Chiropractor	60008781	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	212184	OTHER	IL	MEDICARE PART B PROVIDER

General Provider Information

NPI Number	:	1316133861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO HEIGHTS PAIN CENTER, P.C.

Provider Business Mailing Address
First Line	:	1406 PARK AVE
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-3529
Country	:	US
Telephone Number	:	708-756-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1406 PARK AVE
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-3529
Country	:	US
Telephone Number	:	708-756-3200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RYAN M. ROSENTHAL
Credential	:	D.C.
Telephone Number	:	708-756-3200

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	09/19/2007

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