MEDICARE: ALLEN CHIROPRACTIC ORTHOPEDICS, SC

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	111NX0800X	Orthopedic Chiropractor	042-618253	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2232480	OTHER	IL	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1356401897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEN CHIROPRACTIC ORTHOPEDICS, SC

Provider Business Mailing Address
First Line	:	825 N. CASS AVE.
Second Line	:	SUITE 104
City	:	WESTMONT
State	:	IL
Zip	:	60559-6401
Country	:	US
Telephone Number	:	630-522-4060
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 N. CASS AVE
Second Line	:	SUITE 104
City	:	WESTMONT
State	:	IL
Zip	:	60559-6401
Country	:	US
Telephone Number	:	630-522-4060
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHAWN W ALLEN
Credential	:	DC,DABCO
Telephone Number	:	630-522-4060

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	10/06/2011

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