MEDICARE: BARTLETT CHIROPRACTIC CLINIC, 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	111N00000X	Chiropractor	038010561	IL

General Provider Information

NPI Number	:	1407211832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARTLETT CHIROPRACTIC CLINIC, SC

Provider Business Mailing Address
First Line	:	314 W ROLLINS RD
Second Line	:	STE B
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-1204
Country	:	US
Telephone Number	:	847-546-4220
Fax Number	:	847-546-4262

Provider Business Practice Location Address
First Line	:	314 W ROLLINS RD
Second Line	:	STE B
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-1204
Country	:	US
Telephone Number	:	847-546-4220
Fax Number	:	847-546-4262

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KEITH CHARLES RICHARD
Credential	:	D.C.
Telephone Number	:	321-795-7497

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	12/30/2015

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