MEDICARE: NORTHSIDE CHIROPRACTIC INC

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	038008549	IL

General Provider Information

NPI Number	:	1023130077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSIDE CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	3250 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1117
Country	:	US
Telephone Number	:	773-755-9515
Fax Number	:	773-755-9517

Provider Business Practice Location Address
First Line	:	3250 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1117
Country	:	US
Telephone Number	:	773-755-9515
Fax Number	:	773-755-9517

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL JAMES DUBICK
Credential	:	D.C.
Telephone Number	:	773-755-9515

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	11/28/2011

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Directions to “NORTHSIDE CHIROPRACTIC INC ” Practice Location

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