Provider Demographics
NPI:1053907196
Name:REHAB LAB LLC
Entity type:Organization
Organization Name:REHAB LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:224-456-7165
Mailing Address - Street 1:2236 W CORNELIA AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6035
Mailing Address - Country:US
Mailing Address - Phone:224-456-7165
Mailing Address - Fax:
Practice Address - Street 1:2577 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4324
Practice Address - Country:US
Practice Address - Phone:224-456-7165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty