Healthcare Provider Details

I. General information

NPI: 1215944756
Provider Name (Legal Business Name): ALLYNE R ROSENTHAL DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S MICHIGAN AVE SUITE 1560
CHICAGO IL
60603-6191
US

IV. Provider business mailing address

122 S MICHIGAN AVE SUITE 1560
CHICAGO IL
60603-6191
US

V. Phone/Fax

Practice location:
  • Phone: 312-939-4121
  • Fax: 312-939-8011
Mailing address:
  • Phone: 312-939-4121
  • Fax: 312-939-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: