MEDICARE: DR. BRUCE W GIFFEN D.C.

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		IL

General Provider Information

NPI Number	:	1124241443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE W GIFFEN D.C.

Provider Business Mailing Address
First Line	:	600 N 1ST BANK DR
Second Line	:	SUITE B
City	:	PALATINE
State	:	IL
Zip	:	60067-8185
Country	:	US
Telephone Number	:	847-963-9697
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N 1ST BANK DR
Second Line	:	SUITE B
City	:	PALATINE
State	:	IL
Zip	:	60067-8185
Country	:	US
Telephone Number	:	847-963-9697
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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