MEDICARE: DR. JESSICA TORRES DC

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	038012815	IL

General Provider Information

NPI Number	:	1164888194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA TORRES DC

Provider Business Mailing Address
First Line	:	212 WEBSTER ST
Second Line	:
City	:	MONTGOMERY
State	:	IL
Zip	:	60538-1324
Country	:	US
Telephone Number	:	630-896-1919
Fax Number	:	630-896-1233

Provider Business Practice Location Address
First Line	:	212 WEBSTER ST
Second Line	:
City	:	MONTGOMERY
State	:	IL
Zip	:	60538-1324
Country	:	US
Telephone Number	:	630-896-1919
Fax Number	:	630-896-1233

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

Provider Enumeration Date	:	01/06/2016
Last Update Date	:	02/09/2016

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