MEDICARE: DR. KANELLA M KAPOTAS 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	038006331	IL

General Provider Information

NPI Number	:	1336306059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KANELLA M KAPOTAS D.C.

Provider Business Mailing Address
First Line	:	460 BRIARGATE DR
Second Line	:	SUITE 100
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-2227
Country	:	US
Telephone Number	:	847-488-1600
Fax Number	:	847-488-1611

Provider Business Practice Location Address
First Line	:	460 BRIARGATE DR
Second Line	:	SUITE 100
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-2227
Country	:	US
Telephone Number	:	847-488-1600
Fax Number	:	847-488-1611

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

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	05/20/2008

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