MEDICARE: INTEGRATED HEALTH SOURCE S.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	038012017	IL

General Provider Information

NPI Number	:	1477803286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED HEALTH SOURCE S.C.

Provider Business Mailing Address
First Line	:	2411 WEST JEFFERSON STREET
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60435-6448
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2411 WEST JEFFERSON STREET
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60435-6448
Country	:	US
Telephone Number	:	815-744-3505
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAN CATARELLO
Credential	:
Telephone Number	:	847-254-1492

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	08/27/2013

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