Provider Demographics
NPI:1194939603
Name:CHINATOWN PHYSICAL MEDICINE & REHAB LTD
Entity type:Organization
Organization Name:CHINATOWN PHYSICAL MEDICINE & REHAB LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-842-9831
Mailing Address - Street 1:2134 S ARCHER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1514
Mailing Address - Country:US
Mailing Address - Phone:312-842-9831
Mailing Address - Fax:312-842-1037
Practice Address - Street 1:2134 S ARCHER AVE STE B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1514
Practice Address - Country:US
Practice Address - Phone:312-842-9831
Practice Address - Fax:312-842-1037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632866OtherBCBS
647079OtherACN
7818411OtherAETNA
647079OtherACN