MEDICARE: HOLCOMB FAMILY CHIROPRACTIC

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

General Provider Information

NPI Number	:	1023331170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLCOMB FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	332 SKOKIE VALLEY RD
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-4415
Country	:	US
Telephone Number	:	563-320-0215
Fax Number	:

Provider Business Practice Location Address
First Line	:	332 SKOKIE VALLEY RD
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-4415
Country	:	US
Telephone Number	:	563-320-0215
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. LEA MAE CARLIN
Credential	:	DC
Telephone Number	:	563-320-0215

Provider Enumeration Date	:	03/03/2010
Last Update Date	:	03/03/2010

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