MEDICARE: LAKE COUNTY HEALTH PAIN & REHABILITATION CENTER 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	038-007291	IL
2	111N00000X	Chiropractor	0038-007291	IL

General Provider Information

NPI Number	:	1629270244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE COUNTY HEALTH PAIN & REHABILITATION CENTER S.C

Provider Business Mailing Address
First Line	:	524 N. LAKE STREET
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-1827
Country	:	US
Telephone Number	:	847-949-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	524 N LAKE STREET
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-1827
Country	:	US
Telephone Number	:	847-949-4200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JENNIFER S. RAMOS
Credential	:	DC
Telephone Number	:	847-949-4200

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	06/11/2009

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