LIFESTYLE REJUVENATION MEDICAL GROUP PLLC NPI 1134781974

NPI Information

NPI: 1134781974
Provider Name: LIFESTYLE REJUVENATION MEDICAL GROUP PLLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
1740 E 55TH STREET
CHICAGO, IL
ZIP 60615
Phone: (773) 667-9053
Get Directions

LIFESTYLE REJUVENATION MEDICAL GROUP PLLC is a multi-specialty clinic center in Chicago, IL. LIFESTYLE REJUVENATION MEDICAL GROUP PLLC NPI is 1134781974. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1740 E 55TH STREET
CHICAGO, IL
ZIP 60615
Phone: (773) 667-9053

The provider's authorized official is Robert Van Higginbottom .
The authorized official title is Ceo and has the following contact phone number (773) 667-9053.

The enumeration date for this NPI number is 7/2/2019 and was last updated on 5/29/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	111N00000X	Chiropractor		No
2	111NR0400X	Chiropractor	Rehabilitation	No
3	261QH0100X	Clinic/Center	Health Service	No
4	261QM2500X	Clinic/Center	Medical Specialty	No
5	261QP2000X	Clinic/Center	Physical Therapy	No
6	261QP2300X	Clinic/Center	Primary Care	No
7	261QP3300X	Clinic/Center	Pain	No
8	261QR0200X	Clinic/Center	Radiology	No
9	261QR0400X	Clinic/Center	Rehabilitation	No
10	261QR0800X	Clinic/Center	Recovery Care	No
11	302R00000X	Health Maintenance Organization		No
12	305R00000X	Preferred Provider Organization		No
13	305S00000X	Point of Service		No
14	332B00000X	Durable Medical Equipment & Medical Supplies		No
15	261QM1300X	Clinic/Center	Multi-Specialty	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

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