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General NPI Number Information
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NPI Number | 1508356072
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Entity Type | Organization
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Legal Business Name | HALO MEDICAL PROFESSIONALS SC.
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 08/10/2018
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Provider Practice Location Address
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Address Line | 10650 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643
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Country | US
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Telephone | 773-239-7740
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Fax | 773-239-7745
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Provider Business Mailing Address
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Address Line | 10650 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-3134
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Country | US
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Telephone | 773-239-7740
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Fax | 773-239-7745
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. FREDERIC L. ROBERTSON
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Credential | D.N./D.C.
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Telephone | 773-239-7740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 038007303
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License Number State | IL
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