MEDICARE: RJR MEDICAL, S.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	042620480	IL

General Provider Information

NPI Number	:	1316311160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RJR MEDICAL, S.C.

Provider Business Mailing Address
First Line	:	3358 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4037
Country	:	US
Telephone Number	:	773-313-0750
Fax Number	:	856-441-8304

Provider Business Practice Location Address
First Line	:	3358 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4037
Country	:	US
Telephone Number	:	773-313-0750
Fax Number	:	856-441-8304

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. EUGENE JAO
Credential	:	M.D.
Telephone Number	:	773-313-0750

Provider Enumeration Date	:	11/17/2015
Last Update Date	:	11/17/2015

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