MEDICARE: MR. THEODORE R VITI JR. 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		IL

General Provider Information

NPI Number	:	1356438642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THEODORE R VITI JR. DC

Provider Business Mailing Address
First Line	:	1002 ROHLWING RD
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007
Country	:	US
Telephone Number	:	847-891-1313
Fax Number	:	847-891-1291

Provider Business Practice Location Address
First Line	:	1002 ROHLWING RD
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007
Country	:	US
Telephone Number	:	847-891-1313
Fax Number	:	847-891-1291

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	10/29/2007

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