MEDICARE: DR. ERIKA KRISTIN MENNERICK 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	38010405	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04532282	OTHER	IL	BCBS
2	0007932809	OTHER	IL	AETNA PIN

General Provider Information

NPI Number	:	1316945348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIKA KRISTIN MENNERICK DC

Provider Business Mailing Address
First Line	:	701 E NORTH ST
Second Line	:	STE. B
City	:	ELBURN
State	:	IL
Zip	:	60119-9052
Country	:	US
Telephone Number	:	630-365-5820
Fax Number	:	630-365-5815

Provider Business Practice Location Address
First Line	:	701 E NORTH ST
Second Line	:	STE. B
City	:	ELBURN
State	:	IL
Zip	:	60119-9052
Country	:	US
Telephone Number	:	630-365-5820
Fax Number	:	630-365-5815

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	01/23/2009

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