Provider Demographics
NPI:1194154955
Name:RHICC,LLC
Entity type:Organization
Organization Name:RHICC,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:Z
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:708-529-0413
Mailing Address - Street 1:3860 W 95TH ST
Mailing Address - Street 2:UNIT 6
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2034
Mailing Address - Country:US
Mailing Address - Phone:708-529-7111
Mailing Address - Fax:866-403-6309
Practice Address - Street 1:3860 W 95TH ST
Practice Address - Street 2:UNIT 6
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2034
Practice Address - Country:US
Practice Address - Phone:708-529-7111
Practice Address - Fax:866-403-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011180111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty