Provider Demographics
NPI:1457356396
Name:RICE, ROBERT A (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:RICE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12717 S RIDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2242
Mailing Address - Country:US
Mailing Address - Phone:708-371-6114
Mailing Address - Fax:708-371-0816
Practice Address - Street 1:12717 S RIDGELAND AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2242
Practice Address - Country:US
Practice Address - Phone:708-371-6114
Practice Address - Fax:708-371-0816
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627469OtherBLUE CROSS BLUE SHIELD
T32983Medicare UPIN
IL204761Medicare ID - Type Unspecified