MEDICARE: PETER WILLIAM MCMANUS, D.C. LLC

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	038011427	IL

General Provider Information

NPI Number	:	1316294010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER WILLIAM MCMANUS, D.C. LLC

Provider Business Mailing Address
First Line	:	2551 N CLARK ST STE 605
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4578
Country	:	US
Telephone Number	:	312-244-0413
Fax Number	:

Provider Business Practice Location Address
First Line	:	2551 N CLARK ST STE 605
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4578
Country	:	US
Telephone Number	:	312-244-0413
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MEMBER OF LLC
Name	:	DR. PETER WILLIAM MCMANUS
Credential	:	D.C.
Telephone Number	:	312-244-0413

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	08/13/2012

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