MEDICARE: DR. DANIEL A. DEBOER 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	038-008216	IL
2	111N00000X	Chiropractor	08001736A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RR350043820	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	01622471	OTHER	IL	BLUECROSSBLUESHIELD

General Provider Information

NPI Number	:	1215057344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL A. DEBOER D.C.

Provider Business Mailing Address
First Line	:	2433 ONTARIO ST STE B
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2700
Country	:	US
Telephone Number	:	708-895-1798
Fax Number	:

Provider Business Practice Location Address
First Line	:	2433 ONTARIO ST STE B
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2700
Country	:	US
Telephone Number	:	708-895-1798
Fax Number	:

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	01/31/2022

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