NPIMap

Organization Active NPI

Life Clinic, LLC

  • Neurology Physician
  • Mt Prospect, IL
National Provider Identifier
1043598501
Registry record updated Jun 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
036052025 Issued in IL
Legal business name
LIFE CLINIC, LLC
Practice address
20 E Northwest Hwy
Mt Prospect, IL 60056-3223
Phone
(847) 342-9033
NPI assigned
Aug 1, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Charles Lee, DCNPI 1770645681
Title
Director
Phone
(847) 342-9033

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 038-007948 IL
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X IL
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X 036052025 IL Primary
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X

Addresses

Primary practice location

20 E Northwest Hwy
Mt Prospect, IL 60056-3223

Mailing address

2780 Prince St
Northbrook, IL 60062-6540
Phone (847) 342-9033

Other names 1

  • Genesis Medical, LLC Former legal business name

National Provider Directory

National Provider Directory

Locations

20 E Northwest Hwy
Mt Prospect, IL 60056
Phone (847) 342-9033

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435276800000",
    "number": "1043598501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2780 PRINCE ST",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600626540",
            "telephone_number": "847-342-9033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 E NORTHWEST HWY",
            "city": "MT PROSPECT",
            "state": "IL",
            "postal_code": "600563223",
            "telephone_number": "847-342-9033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-01",
        "last_updated": "2015-06-26",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "847-342-9033",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-007948",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036052025",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Medical, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Mt Prospect, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.