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General NPI Number Information
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NPI Number | 1811218050
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Entity Type | Organization
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Legal Business Name | BRUCE RACHUM, D.C., PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/22/2010
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Last Update Date | 06/22/2010
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Provider Practice Location Address
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Address Line | 6430 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2310
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Country | US
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Telephone | 708-749-0100
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Fax | 708-749-7497
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Provider Business Mailing Address
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Address Line | 6430 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2310
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Country | US
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Telephone | 708-749-0100
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Fax | 708-749-7497
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. BRUCE RACHUM
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Credential | D.C.
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Telephone | 708-749-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038 007062
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License Number State | IL
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