NPIMap

Organization Active NPI

Axis Medical Management Goup SC

Doing business as New Life Medical Center

  • Rehabilitation Chiropractor
  • Chicago, IL
National Provider Identifier
1932221397
Registry record updated Apr 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
042.618397038.010225 Issued in IL
Legal business name
AXIS MEDICAL MANAGEMENT GOUP SC
Doing business as
New Life Medical Center
Practice address
4111 W 26TH St
Suite 110
Chicago, IL 60623-4313
Phone
(773) 542-1111
Fax
(773) 542-7100
NPI assigned
Apr 5, 2007
Last updated
Apr 25, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2008

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

Authorized official

Name
Jan Struwe
Title
Office Manager
Phone
(773) 542-1111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Chiropractor 111NR0400X 042.618397038.010225 IL Primary

Addresses

Primary practice location

4111 W 26TH St
Suite 110
Chicago, IL 60623-4313

Mailing address

4111 W 26TH St
Suite 110
Chicago, IL 60623-4313
Phone (773) 542-1111

Other identifiers 1

IdentifierTypeStateIssuer
1634898OtherILBLUE CROSS BLUE SHIELD ID

Other names 1

  • New Life Medical Center Doing business as

National Provider Directory

National Provider Directory

Locations

311 S Wacker Dr
Chicago, IL 60606

4111 W 26th St
Ste 110
Chicago, IL 60623
Phone (773) 542-1111

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1175731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209081600000",
    "number": "1932221397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111 W 26TH ST",
            "address_2": "SUITE 110",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606234313",
            "telephone_number": "773-542-1111",
            "fax_number": "773-542-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 W 26TH ST",
            "address_2": "SUITE 110",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606234313",
            "telephone_number": "773-542-1111",
            "fax_number": "773-542-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXIS MEDICAL MANAGEMENT GOUP SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-05",
        "last_updated": "2008-04-25",
        "status": "A",
        "authorized_official_last_name": "STRUWE",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "773-542-1111"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "IL",
            "license": "042.618397038.010225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD ID",
            "identifier": "1634898",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Life Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2008; 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.