MEDICARE: DR. DANA R BALDINO 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	038-011528	IL

General Provider Information

NPI Number	:	1699001578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANA R BALDINO D.C.

Provider Business Mailing Address
First Line	:	2401 W US HIGHWAY 20
Second Line	:	SUITE 201
City	:	PINGREE GROVE
State	:	IL
Zip	:	60140-8818
Country	:	US
Telephone Number	:	847-453-4953
Fax Number	:	847-453-4932

Provider Business Practice Location Address
First Line	:	2401 W US HIGHWAY 20
Second Line	:	SUITE 201
City	:	PINGREE GROVE
State	:	IL
Zip	:	60140-8818
Country	:	US
Telephone Number	:	847-453-4953
Fax Number	:	847-456-4932

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

Provider Enumeration Date	:	10/27/2009
Last Update Date	:	03/01/2012

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