MEDICARE: INTERCHANGE MEDICAL WELLNESS CENTER

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	:	1578882940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERCHANGE MEDICAL WELLNESS CENTER

Provider Business Mailing Address
First Line	:	1147 S WABASH AVE # 250
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2346
Country	:	US
Telephone Number	:	312-235-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1147 S WABASH AVE # 250
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2346
Country	:	US
Telephone Number	:	312-235-0900
Fax Number	:

Authorized Official
Title or Position	:	OWNER CHIROPRACTIC PHYSICIAN
Name	:	DR. AMANDA HERZER
Credential	:	D.C.
Telephone Number	:	312-451-4961

Provider Enumeration Date	:	05/25/2010
Last Update Date	:	05/25/2010

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Directions to “INTERCHANGE MEDICAL WELLNESS CENTER ” Practice Location

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