MEDICARE: DR. ROBERT A RICE DC

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	038-008224	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1627469	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1457356396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT A RICE DC

Provider Business Mailing Address
First Line	:	12717 S RIDGELAND AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2242
Country	:	US
Telephone Number	:	708-371-6114
Fax Number	:	708-371-0816

Provider Business Practice Location Address
First Line	:	12717 S RIDGELAND AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2242
Country	:	US
Telephone Number	:	708-371-6114
Fax Number	:	708-371-0816

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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