Healthcare Provider Details

I. General information

NPI: 1821632423
Provider Name (Legal Business Name): RACHEL NICOLE LEIBOVITZ DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 W BELMONT AVE
CHICAGO IL
60657-4511
US

IV. Provider business mailing address

624 W BELMONT AVE
CHICAGO IL
60657-4511
US

V. Phone/Fax

Practice location:
  • Phone: 773-868-0347
  • Fax:
Mailing address:
  • Phone: 773-868-0347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.013461
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: