MEDICARE: DR. SHANNON L CHIDLOW 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9928211	OTHER	IL	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1245266287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON L CHIDLOW DC

Provider Business Mailing Address
First Line	:	3626 GREEN ST
Second Line	:
City	:	STEGER
State	:	IL
Zip	:	60475-1628
Country	:	US
Telephone Number	:	708-754-0777
Fax Number	:	708-754-0770

Provider Business Practice Location Address
First Line	:	22 E 33RD PL
Second Line	:
City	:	STEGER
State	:	IL
Zip	:	60475-1181
Country	:	US
Telephone Number	:	708-754-0777
Fax Number	:

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	07/08/2007

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