=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245456185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAN F. BAIN DO SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 E WASHINGTON ST 3305
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60602-2103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-236-7010
-----------------------------------------------------
Fax | 312-236-7190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 E WASHINGTON ST 3305
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60602-2103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-236-7010
-----------------------------------------------------
Fax | 312-236-7190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALAN FREDERICK BAIN
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 312-236-7010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------