Pro-Active Care Physical Medicine SC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038010690 Issued in IL

Legal business name

PRO-ACTIVE CARE PHYSICAL MEDICINE SC

Practice address

2609 W Lawrence Ave
Chicago, IL 60625-6895

Phone

(773) 279-9344

Fax

(773) 279-9345

NPI assigned

May 4, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Rae Bouvin, D.C.NPI 1891727145

Title

P

Phone

(773) 279-9344

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

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

• Rae Marie Bouvin, D.C.

  • Chiropractor
  • Chicago, IL
  • NPI 1891727145
  Medicare reassignment NPD Authorized official
• Eliza Shin, MD

  • Diagnostic Radiology Physician
  • Chicago, IL
  • NPI 1306836945
  NPD (past)

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

{
    "created_epoch": "1336089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454976000000",
    "number": "1356600712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2609 W LAWRENCE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606256895",
            "telephone_number": "773-279-9344",
            "fax_number": "773-279-9345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2609 W LAWRENCE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606256895",
            "telephone_number": "773-279-9344",
            "fax_number": "773-279-9345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO-ACTIVE CARE PHYSICAL MEDICINE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-04",
        "last_updated": "2016-02-09",
        "status": "A",
        "authorized_official_last_name": "BOUVIN",
        "authorized_official_first_name": "RAE",
        "authorized_official_title_or_position": "P",
        "authorized_official_telephone_number": "773-279-9344",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038010690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "IL7812",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pro Dental Il - Chad Wise PC (Destiny Dental of Chatham)
• Pro Dental Il - Chad Wise PC (Destiny Dental of Jeffery)
• Pro Pharmacy Inc
• Pro Sports & Spine Rehabilitation, SC
• Pro Vita Home Care, LLC.
• Pro-Active Chiropractic & Physiotherapy (TRIFACTIVE Premium Sports Injury and Pain Clinic)
• Pro-Holistic Institute S.C.
• Pro-West Pharmacy
• Michael Pro, DPT
• Proactive Natural Medicine, LTD

• Chiropractor in Chicago, IL
• Providers in Chicago, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2016; 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.