MEDICARE: CONCEPT CARE CHIROPRACTIC AND WELLNESS CENTER SC

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

General Provider Information

NPI Number	:	1518192335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCEPT CARE CHIROPRACTIC AND WELLNESS CENTER SC

Provider Business Mailing Address
First Line	:	6230 MAIN ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-1908
Country	:	US
Telephone Number	:	630-960-9914
Fax Number	:	630-960-9924

Provider Business Practice Location Address
First Line	:	6230 MAIN ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-1908
Country	:	US
Telephone Number	:	630-960-9914
Fax Number	:	630-960-9924

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES DANIEL KIRK
Credential	:	D.C.
Telephone Number	:	630-960-9914

Provider Enumeration Date	:	05/22/2009
Last Update Date	:	08/27/2020

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