MEDICARE: DR. JARED T. LILES 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	038011548	IL

General Provider Information

NPI Number	:	1487981791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JARED T. LILES D.C.

Provider Business Mailing Address
First Line	:	238 W MAIN ST
Second Line	:	P.O. BOX 424
City	:	LENA
State	:	IL
Zip	:	61048-9770
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 W MAIN ST
Second Line	:
City	:	LENA
State	:	IL
Zip	:	61048-9770
Country	:	US
Telephone Number	:	815-369-4974
Fax Number	:

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

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

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