Provider Demographics
NPI:1194087767
Name:MEDICAL ELEMENT, SC
Entity type:Organization
Organization Name:MEDICAL ELEMENT, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAFIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-229-0031
Mailing Address - Street 1:233 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-4637
Mailing Address - Country:US
Mailing Address - Phone:312-229-0031
Mailing Address - Fax:312-948-9193
Practice Address - Street 1:233 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-4637
Practice Address - Country:US
Practice Address - Phone:312-229-0031
Practice Address - Fax:312-948-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010642111N00000X
IL038008248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5687001Medicare PIN