Provider Demographics
NPI:1972791184
Name:HAUSCH, MICHAEL WILLIAM (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:HAUSCH
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 1:11001 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2221
Mailing Address - Country:US
Mailing Address - Phone:773-585-5550
Mailing Address - Fax:773-585-1061
Practice Address - Street 1:11001 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2221
Practice Address - Country:US
Practice Address - Phone:773-585-5550
Practice Address - Fax:773-585-1061
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623616OtherBLUE CROSS BLUE SHIELD
IL364356477OtherUNICARE
IL364356477OtherUNITED HEALTH CARE
IL350049294OtherRAILROAD MEDICARE
IL4046624OtherCIGNA HEALTH CARE
IL364356477OtherGREAT WEST
IL7972161OtherAETNA
IL364356477OtherHUMANA
IL1623616OtherBLUE CROSS BLUE SHIELD
ILK46122Medicare PIN