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General NPI Number Information
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NPI Number | 1992504831
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Entity Type | Individual
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Provider Name | RAHUL BHAKTA DC
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Gender | Male
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 1101 S CANAL ST STE 102
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City | CHICAGO
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State | IL
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Zip | 60607-4935
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Country | US
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Telephone | 312-424-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 1841 W 21ST ST UNIT 3W
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City | CHICAGO
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State | IL
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Zip | 60608-2714
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Country | US
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Telephone | 507-491-8360
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 038.014122
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License Number State | IL
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