MEDICARE: DR. MICHAEL SALOMON 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01635767	OTHER	IL	BC/BS PROVIDER #

General Provider Information

NPI Number	:	1295709681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SALOMON D.C.

Provider Business Mailing Address
First Line	:	1870 S BLUE ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3013
Country	:	US
Telephone Number	:	131-249-2978
Fax Number	:	773-767-3944

Provider Business Practice Location Address
First Line	:	1870 S BLUE ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3013
Country	:	US
Telephone Number	:	131-249-2978
Fax Number	:	773-767-3944

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	07/09/2007

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