MEDICARE: EZ SPINE AND JOINT REHAB INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1124809280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EZ SPINE AND JOINT REHAB INC.

Provider Business Mailing Address
First Line	:	3524 MILWAUKEE AVE
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-7130
Country	:	US
Telephone Number	:	847-296-1600
Fax Number	:	224-361-3550

Provider Business Practice Location Address
First Line	:	3524 MILWAUKEE AVE
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-7130
Country	:	US
Telephone Number	:	847-296-1600
Fax Number	:	224-361-3550

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HANSEOK OH
Credential	:	DPT
Telephone Number	:	224-616-7021

Provider Enumeration Date	:	10/13/2023
Last Update Date	:	10/13/2023

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