MEDICARE: DR. TOM DAN PAPPAS 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01621673	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1639247240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOM DAN PAPPAS D.C.

Provider Business Mailing Address
First Line	:	5237 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4210
Country	:	US
Telephone Number	:	773-286-7118
Fax Number	:	773-286-1287

Provider Business Practice Location Address
First Line	:	5237 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4210
Country	:	US
Telephone Number	:	773-286-7118
Fax Number	:	773-286-1287

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/09/2007

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