MEDICARE: DR. ALLYNE R ROSENTHAL 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	111NI0900X	Internist Chiropractor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1682669	OTHER	IL	BCBS PROVIDER

General Provider Information

NPI Number	:	1215944756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLYNE R ROSENTHAL DC

Provider Business Mailing Address
First Line	:	122 S MICHIGAN AVE
Second Line	:	SUITE 1560
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	:	SUITE 1560
City	:	CHICAGO
State	:	IL
Zip	:	60603-6191
Country	:	US
Telephone Number	:	312-939-4121
Fax Number	:	312-939-8011

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	11/16/2007

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Directions to “ DR. ALLYNE R ROSENTHAL DC” Practice Location

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