MEDICARE: GARY ROEBEN 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	038009502	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02230328	OTHER		BCBS

General Provider Information

NPI Number	:	1447292750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY ROEBEN DC

Provider Business Mailing Address
First Line	:	2625 BUTTERFIELD RD
Second Line	:	STE 301N
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1234
Country	:	US
Telephone Number	:	630-320-6400
Fax Number	:	630-701-1007

Provider Business Practice Location Address
First Line	:	2625 BUTTERFIELD RD
Second Line	:	STE 301N
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1234
Country	:	US
Telephone Number	:	630-320-6400
Fax Number	:	630-701-1007

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/23/2015

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Directions to “ GARY ROEBEN DC” Practice Location

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