MEDICARE: SPINEREHABCENTER

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	038011224	IL

General Provider Information

NPI Number	:	1427294024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINEREHABCENTER

Provider Business Mailing Address
First Line	:	5019 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3800
Country	:	US
Telephone Number	:	312-523-6385
Fax Number	:

Provider Business Practice Location Address
First Line	:	5019 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3800
Country	:	US
Telephone Number	:	312-523-6385
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. JAMSHIED BAKSHODEH
Credential	:	DC
Telephone Number	:	312-523-6385

Provider Enumeration Date	:	01/02/2009
Last Update Date	:	01/02/2009

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Directions to “SPINEREHABCENTER ” Practice Location

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