MEDICARE: JEROME R. OLIVER 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	0380070215	IL

General Provider Information

NPI Number	:	1417078635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME R. OLIVER D.C.

Provider Business Mailing Address
First Line	:	8054 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-5936
Country	:	US
Telephone Number	:	773-776-5700
Fax Number	:	773-776-5800

Provider Business Practice Location Address
First Line	:	8054 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-5936
Country	:	US
Telephone Number	:	773-776-5700
Fax Number	:	773-776-5800

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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