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PRO-ACTIVE CARE PHYSICAL MEDICINE SC
NPI 1356600712
Chiropractor in Chicago, IL

Active since May 04, 2012CLIA 14D2122278 · Waiver
2609 W LAWRENCE AVE, CHICAGO, IL 60625(773) 279-9344(773) 279-9345 Get Directions Write a Review

NPPES record last updated: February 9, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Pro-active Care Physical Medicine Sc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRO-ACTIVE CARE PHYSICAL MEDICINE SC (NPI 1356600712) is a healthcare organization registered as a chiropractor in Chicago, Illinois and active in the NPI registry since May 2012. The organization holds a CLIA Waiver certificate valid through November 22, 2026 and lists Rae Bouvin, P, as its authorized official.

NPPES Registry Identity

NPI1356600712
Entity TypeOrganization
Primary Taxonomy111N00000X
Legal Business NamePRO-ACTIVE CARE PHYSICAL MEDICINE SC
Location Address2609 W LAWRENCE AVEChicago, IL 60625-6895
Mailing Address2609 W Lawrence AveChicago, IL 60625-6895 · (773) 279-9344 · Fax (773) 279-9345
Phone(773) 279-9344
Fax(773) 279-9345
Organization SubpartNo
Authorized OfficialRae BouvinP · (773) 279-9344
Enumeration DateMay 4, 2012
Last NPPES UpdateFebruary 9, 2016
✔ NPI 1356600712 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyChiropractorChiropractic Providers
Taxonomy Code111N00000X
License✔ Licensed in IL · 038010690
Definition
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
2609 W LAWRENCE AVE, Chicago, IL 60625
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Other Identifiers 2

OtherIL7812IL · Medicare Ptan
Medicare UPIN417010377IL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D2122278

Pro-Active Care · Chicago, IL
Active · expires Nov 22, 2026
CLIA Number14D2122278
Laboratory TypePhysician Office
Certificate Effective DateNovember 23, 2024
Certificate Expiration DateNovember 22, 2026
Laboratory DirectorEdgardo R. Vargas
Laboratory Phone(773) 279-9344
Laboratory LocationPro-Active Care4430 N Western Ave, Chicago, IL 60625
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pro-Active Care Physical Medicine Sc's NPI number?

The NPI number for Pro-Active Care Physical Medicine Sc is 1356600712. It was assigned to this organization in the NPPES registry on May 4, 2012.

Where is Pro-Active Care Physical Medicine Sc located?

Pro-Active Care Physical Medicine Sc is located at 2609 W Lawrence Ave, Chicago, IL 60625. The listed phone number is (773) 279-9344.

What is Pro-Active Care Physical Medicine Sc's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Does Pro-Active Care Physical Medicine Sc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2122278) is associated with this NPI, valid through November 22, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Pro-Active Care Physical Medicine Sc was last updated on February 9, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.