MEDICARE: FAMILY CHIROPRACTIC CLINIC OF WEST CHICAGO

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02207202	OTHER	IL	BLUECROSS AND BLUESHIELD

General Provider Information

NPI Number	:	1043334881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CHIROPRACTIC CLINIC OF WEST CHICAGO

Provider Business Mailing Address
First Line	:	117 W ROOSEVELT RD
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3765
Country	:	US
Telephone Number	:	630-876-9191
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 W ROOSEVELT RD
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3765
Country	:	US
Telephone Number	:	630-876-9191
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHARON ELLEN WERNER
Credential	:	D.C.
Telephone Number	:	630-876-9191

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	08/22/2020

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Directions to “FAMILY CHIROPRACTIC CLINIC OF WEST CHICAGO ” Practice Location

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