MEDICARE: DR. ANGIE RECENDEZ 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	111NP0017X	Pediatric Chiropractor	038012327	IL

General Provider Information

NPI Number	:	1326435272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGIE RECENDEZ D.C.

Provider Business Mailing Address
First Line	:	4614 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-4040
Country	:	US
Telephone Number	:	630-923-5468
Fax Number	:

Provider Business Practice Location Address
First Line	:	4614 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-4040
Country	:	US
Telephone Number	:	773-563-4434
Fax Number	:

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

Provider Enumeration Date	:	04/17/2015
Last Update Date	:	08/06/2016

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