MEDICARE: FUNCTIONAL HEALTH SC

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	038009577	IL

General Provider Information

NPI Number	:	1174921571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNCTIONAL HEALTH SC

Provider Business Mailing Address
First Line	:	122 S MICHIGAN AVE
Second Line	:	STE. 1265
City	:	CHICAGO
State	:	IL
Zip	:	60603-6191
Country	:	US
Telephone Number	:	312-939-4121
Fax Number	:	312-939-8011

Provider Business Practice Location Address
First Line	:	122 S MICHIGAN AVE
Second Line	:	STE. 1265
City	:	CHICAGO
State	:	IL
Zip	:	60603-6191
Country	:	US
Telephone Number	:	312-939-4121
Fax Number	:	312-939-8011

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRIS EDGINTON
Credential	:	D.C.
Telephone Number	:	773-931-6578

Provider Enumeration Date	:	12/17/2014
Last Update Date	:	12/17/2014

Similar Medicare Providers

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Practice Location Address:

122 S MICHIGAN AVE , 7S
CHICAGO, IL
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Practice Phone: 312-814-4846
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1326045089 — DR. NORMAN V KOHN MD
Practice Location Address:

122 S MICHIGAN AVE , SUITE 1300
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Practice Fax:

1487614517 — MR. DOUGLAS ALLAN JAMES D.D.S.
Practice Location Address:

122 SOUTH MICHIGAN AVENUE , MICHIGAN AVENUE DENTAL ASSOCIATES SUITE 1212
CHICAGO, IL
60603-6191

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1386604221 — DR. JAMES M FISCH
Practice Location Address:

122 S MICHIGAN AVE , RM. 1321A
CHICAGO, IL
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1831147909 — DR. PAIGE ANNE MOORE D.D.S
Practice Location Address:

122 S MICHIGAN AVE
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60603-6191

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1407801574 — LAUREN RAUCH KERN MD
Practice Location Address:

122 S. MICHIGAN AVE , SUITE 1317
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1306892518 — MR. JOEL A SUSMAN MSW
Practice Location Address:

122 S MICHIGAN AVE , SUITE 1447
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60603-6191

Practice Phone: 773-975-0290
Practice Fax:

Directions to “FUNCTIONAL HEALTH SC ” Practice Location

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