MEDICARE: CATALYST CHIROPRACTIC LLC

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	038012158	IL

General Provider Information

NPI Number	:	1053669580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATALYST CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	313 W MAPLE ST
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-1633
Country	:	US
Telephone Number	:	815-312-4922
Fax Number	:	773-337-9106

Provider Business Practice Location Address
First Line	:	313 W MAPLE ST
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-1633
Country	:	US
Telephone Number	:	815-312-4922
Fax Number	:	773-337-9106

Authorized Official
Title or Position	:	BILLING COORDINATOR
Name	:	LYNNETTE MCROY
Credential	:
Telephone Number	:	773-767-3822

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	08/20/2013

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