MEDICARE: IRVING PARK REHABILITATION CENTER SC

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	038009107	IL

General Provider Information

NPI Number	:	1194966812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRVING PARK REHABILITATION CENTER SC

Provider Business Mailing Address
First Line	:	1923 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2407
Country	:	US
Telephone Number	:	773-880-0880
Fax Number	:

Provider Business Practice Location Address
First Line	:	1923 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2407
Country	:	US
Telephone Number	:	773-880-0880
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MAX LAZAROWICH
Credential	:	D.C.
Telephone Number	:	773-880-0880

Provider Enumeration Date	:	03/09/2009
Last Update Date	:	03/09/2009

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