MEDICARE: DR. MICHAEL J GONTAREK 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	038.013326	IL

General Provider Information

NPI Number	:	1467917856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J GONTAREK DC

Provider Business Mailing Address
First Line	:	1500 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-2517
Country	:	US
Telephone Number	:	312-787-7850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-2517
Country	:	US
Telephone Number	:	312-787-7850
Fax Number	:

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

Provider Enumeration Date	:	02/10/2019
Last Update Date	:	02/10/2019

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