MEDICARE: MIDWEST CHIROPRACTIC GROUP, SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038007596	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023056967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST CHIROPRACTIC GROUP, SC

Provider Business Mailing Address
First Line	:	PO BOX 1106
Second Line	:
City	:	HUNTLEY
State	:	IL
Zip	:	60142-1106
Country	:	US
Telephone Number	:	815-338-3338
Fax Number	:	815-338-3337

Provider Business Practice Location Address
First Line	:	1666 S EASTWOOD DR
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-4655
Country	:	US
Telephone Number	:	815-338-3338
Fax Number	:	815-338-3337

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. HARSHADBHAI N. PATEL
Credential	:	D.C.
Telephone Number	:	815-338-3338

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	06/24/2008

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