MEDICARE: CHINATOWN PHYSICAL MEDICINE & REHAB LTD

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	038-003513	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01632866	OTHER	IL	BCBS
2	647079	OTHER		ACN
3	7818411	OTHER		AETNA

General Provider Information

NPI Number	:	1194939603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHINATOWN PHYSICAL MEDICINE & REHAB LTD

Provider Business Mailing Address
First Line	:	2134 S ARCHER AVE STE B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1514
Country	:	US
Telephone Number	:	312-842-9831
Fax Number	:	312-842-1037

Provider Business Practice Location Address
First Line	:	2134 S ARCHER AVE STE B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1514
Country	:	US
Telephone Number	:	312-842-9831
Fax Number	:	312-842-1037

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GREGORY Y ING
Credential	:	D.C.
Telephone Number	:	312-842-9831

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	11/21/2008

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