Ivan Robert Bracic, D.C.

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

038007449 Issued in IL

Practice address

1720 Grand Ave
Waukegan, IL 60085-3502

Phone

(847) 625-0202

Fax

(847) 625-0101

NPI assigned

Jan 4, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Novare Medical and Wellness Inc

  • General Practice Physician
  • Fort Myers, FL
  • NPI 1326936329
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218153600000",
    "number": "1114074168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600853502",
            "telephone_number": "847-625-0202",
            "fax_number": "847-625-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600853502",
            "telephone_number": "847-625-0202",
            "fax_number": "847-625-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACIC",
        "first_name": "IVAN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2008-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "IL",
            "license": "038007449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD IL",
            "identifier": "04932043",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melanie Bonanno, APN
• Henri William Boodee, MD
• Emily Borland
• Botkins Dialysis LLC
• Judith Bowman, MD
• Caitlin Bracy
• Carl Bradford
• Sara Bradley
• Timothy Brandt
• Tara Shawnise Brannon

• Rehabilitation Chiropractor in Waukegan, IL
• Providers in Waukegan, IL by specialty
• Rehabilitation Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.