Full Life Rejuvenation

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038.011644 Issued in IL

Legal business name

FULL LIFE REJUVENATION

Practice address

1446 Techny Rd
Northbrook, IL 60062-5447

Phone

(847) 736-9555

Fax

(847) 386-6270

NPI assigned

Dec 30, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Kim Jacobs Martin, DCNPI 1053454140

Title

Chiropractor/Owner

Phone

(847) 736-9555

Specialties & licenses 1

Addresses

Other names 1

• North Shore Health Solutions ltd Doing business as

Locations

Practitioners 1

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

• Kim Jacobs Martin, D.C.

  • Nutrition Chiropractor
  • Northbrook, IL
  • NPI 1053454140
  NPD (past) Authorized official

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

{
    "created_epoch": "1325203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325203200000",
    "number": "1477823938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1446 TECHNY RD",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600625447",
            "telephone_number": "847-736-9555",
            "fax_number": "847-386-6270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1446 TECHNY RD",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600625447",
            "telephone_number": "847-736-9555",
            "fax_number": "847-386-6270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL LIFE REJUVENATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-30",
        "last_updated": "2011-12-30",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "JACOBS",
        "authorized_official_title_or_position": "CHIROPRACTOR/OWNER",
        "authorized_official_telephone_number": "847-736-9555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.011644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Shore Health Solutions ltd",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kaitlyn Frisby
• Steven J. Frisch, PSY.D.
• Laura Fritzsche
• Emma E Frye-Wasi
• Fuel Physical Therapy and Wellness
• Lauren Fulton, LCSW
• Functional Medical Wellness Center , LLC
• Anna Katerina Funk
• Joan Eileen Funk, PSY.D.
• Elizabeth Fyfe, M.S. CCC-SLP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2011; 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.