MEDICARE: DR. RYAN JAMES HALLUM D.C.

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	038010131	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5632113	OTHER	IL	BCBS OF IL PROVIDER ID#

General Provider Information

NPI Number	:	1245393560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN JAMES HALLUM D.C.

Provider Business Mailing Address
First Line	:	43 W ACORN LN
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-4804
Country	:	US
Telephone Number	:	847-658-8541
Fax Number	:	847-658-7395

Provider Business Practice Location Address
First Line	:	43 W ACORN LN
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-4804
Country	:	US
Telephone Number	:	847-658-8541
Fax Number	:	847-658-7395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/23/2025

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