MEDICARE: MICHAEL KOTULA 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	038009025	IL

General Provider Information

NPI Number	:	1366597353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL KOTULA D.C.

Provider Business Mailing Address
First Line	:	106 E PUBLIC SQ
Second Line	:
City	:	KNOXVILLE
State	:	IL
Zip	:	61448-1300
Country	:	US
Telephone Number	:	309-289-9777
Fax Number	:	309-289-9777

Provider Business Practice Location Address
First Line	:	106 E PUBLIC SQ
Second Line	:
City	:	KNOXVILLE
State	:	IL
Zip	:	61448-1300
Country	:	US
Telephone Number	:	309-289-9777
Fax Number	:	309-289-9777

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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Directions to “ MICHAEL KOTULA D.C.” Practice Location

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