MEDICARE: DR. PAUL C. MACH DN

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	172P00000X	Naprapath	181000180	IL
2	133NN1002X	Nutrition Education Nutritionist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	181-000180	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1487733713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL C. MACH DN

Provider Business Mailing Address
First Line	:	3129 SPAULDING ORCHARD RD
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-7318
Country	:	US
Telephone Number	:	217-638-6224
Fax Number	:

Provider Business Practice Location Address
First Line	:	3129 SPAULDING ORCHARD RD
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-7318
Country	:	US
Telephone Number	:	217-638-6224
Fax Number	:

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	06/19/2009

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